Nursing Assessment in Family Health Practice

Family Health Nursing Practice

Involves a set of actions 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 well being among its members.

Family Nurse Practitioner

Meets the health care needs of the family by providing health assessments, direct care, and guidance, teaching or counseling as appropriate, particularly around family self care.

Levels of Nursing assessment

First level Assessment
Data gathering and analysis on what health conditions or problems exist and why it exists

Second level Assessment

Explanations about the familys problems related to maintaining wellness and/or provide a home environment conducive to health maintenance and personal development.

Primary Assessment
Is a process where existing and potential health conditions or problems of the family are determined. Four Categories: Wellness state, Health threats, Health deficits, Stress points or foreseeable crisis situations

Wellness State
Wellness is generally used to mean a healthy balance of the mind, body and spirit that results in an overall feeling of well-being. Wellness is a view of health that emphasizes the state of the entire being and its ongoing development. Determinants of wellness:
better understanding of concepts like destiny, health practices, spirituality, family, environment, work, money and security, health services, social support and leisure.

Health Threats
Conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential
Risk factors of specific disease
Family size beyond family resources Accident hazards Unhealthy nutritional/eating habits or feeding techniques practices Stress-provoking factors Poor environmental condition/sanitation Unsanitary food handling & preparation Lack/Inadequate immunization Family disunity

Health Deficits
Instances of failure in health maintenance
Illness states Failure to thrive/develop Disability

Stress Points/Foreseeable Crisis

Anticipated periods of unusual demand on the individual or family in terms of adjustment, family or resources
Marriage Pregnancy Parenthood Additional member\ Divorce or separation Loss of jobs Hospitalizations Death of a member Adolescence School entrance

Second-Level Assessment
The nature or type of nursing problems that the family encounters in performing the health tasks with respect to a given health condition or problem, and the etiology or barriers to the familys assumption of these tasks.

Second-Level Assessment
1.

2.

3.

4.

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 reason why. If the family recognizes the presence of the condition or problem, determine if something has been done 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 condition or problem, determine if the solution is effective. Determine if the family encounter other problems in implementing the interventions for the wellness state/potential, health threat, health deficit or crisis. Determine how all the other members are affected by the wellness state/potential, health threat, health deficit or stress point.

STEPS IN FAMILY NURSING ASSESSMENT

Data Collection Data Analysis/ Interpretation Diagnosis/Problem definition

Types of data which will generate the categories of health problem

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

Family Structure, Characteristic & Dynamics

1. 2. 3. 4. 5. 6. Members of the family and relationship to the head Demographic data-age, sex, civil status, position Place of residence of each member Type of family structure e.g. nuclear/extended Dominant family member in decision making General family relationship/dynamics

Socio-economic and Cultural Characteristics

1.

Income and expenses

a. b. c. Occupation, work place & income of working member Adequacy to meet basic necessities Who makes decisions about money and how it is spent

2. 3. 4. 5.

Educational attainment of each member Ethnic background and religious affiliation Significant others role they play in familys life Relationship of family to larger community

Home and Environment

1. Housing
a. b. c. d. e. f. g. h. Adequacy of living space / Sleeping arrangement Presence of breeding sites of vectors & diseases Presence of accident hazards Food storage and cooking facilities Water supply source , ownership, potability Toilet facility type, ownership, sanitary condition Garbage disposal type, sanitary condition Drainage system type, sanitary condition

2. 3. 4.

Kind of neighborhood e.g. congested, slum, etc Social and health facilities available Communication and transportation facilities available

Health Status of Each Family Member

1. 2. Medical and nursing history current or past illnesses Nutritional assessment
a. Anthropometric data weight, height, body mass index b. Dietary history specifying quality/quantity of food intake per day c. Eating / Feeding habits and practices

3. 4. 5. 6.

Developmental assessment of infants, toddlers and preschoolers (MMDST) Risk factor assessment predisposing and contributing factors Physical assessment indicating presence of illness state/s Results of laboratory/diagnostic and other screening procedures

Values, Habits, Practices on Health

1. Immunization status of family members 2. Healthy lifestyle practices 3. Adequacy of: a. Rest and sleep b. Exercise and activity c. Use of protective measures d. Relaxation & other stress management activities 4. Use of promotive-preventive health services

Data Analysis
1.Sort data 2. Cluster/Group Related Data 3. Distinguish relevant from Irrelevant Data 4. Identify Patterns 5. Compare patterns with Norms or Standards 6. Interpret Results 7. Make Inferences/Draw Conclusions

Classification of Standards/Norms
1.Normal health of individual members 2. Home and environmental conditions conducive to health development, and 3.Family characteristics, dynamics or level of functioning conducive to family development

Standards/Norms of a Functioning Family Unit

1.
2. 3. 4. 5.

Recognize the presence of a wellness state or health condition or problem Make decisions about taking appropriate health action to maintain wellness or manage the health problem Provide nursing care to the sick, disabled, dependent or at-risk members Maintain a home environment conducive to health maintenance and personal development Utilize community resources for health care

Family Characteristics
Constitutes the clients ability as a system to maintain its integrity and achieve its purpose through a dynamic interchange among its members while responding to the external multi-environments along a time continuum.

Characteristics of healthy family functioning:

Flexible role patterns Responsiveness to needs of individual members Dynamic problem mechanism Ability to accept help Open communication patterns Experience of trust and respect in a warm and caring atmosphere Capacity to maintain and create constructive relationships with the broader neighborhood and community.

Nursing Diagnoses: Family Nursing Problems

A wellness state or health condition becomes a nursing problem when it is stated as: the familys failure to perform adequately specific health tasks to enhance the wellness state or manage the health problems.

Typology Of Nursing Problems In Family Nursing Practice

FIRST-LEVEL ASSESSMENT 1. 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(NANDA,2001)

Wellness Potential
Is a nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data but no explicit expression of client desire.

Readiness for Enhanced Wellness

A nursing judgment on wellness state or condition based on clients current competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function

A. Potential for Enhanced Capability for:

1. 2. 3. 4. 5. Healthy Lifestyle Health Maintenance/Health Management Parenting Breastfeeding Spiritual Well-being

B. Readiness for Enhanced Capability For:

1. 2. 3. 4. 5. Healthy Lifestyle Health maintenance/Health management Parenting Breastfeeding Spiritual Well-Being

II. Presence of Health threats

A conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. Examples: a. Presence of risk factors of specific diseases b. Threat of cross infection c. Family size beyond what family resources d. Accident hazards

E. Faulty/Unhealthful nutritional/eating habits or Feeding techniques practices F. Stress-provoking factors G. Poor home/Environmental Condition/Sanitation H. Unsanitary food handling and preparation I. Unhealthful lifestyle and personal habits/Practices

J. Inherent personal characteristics k. Health history L. Inappropriate role assumption M. Lack of Immunization N. Family Disunity

III. Presence of health Deficits

Instances of failure in health maintenance. Examples: Illness states Failure to thrive/develop according to normal rate Disability

IV. Presence of Stress Points/Foreseeable Crisis

Anticipated periods of unusual demand on the individual or family in terms of adjustment resources. Ex. a. Marriage b. Pregnancy c. Parenthood d. Additional member 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. 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, 1. Social stigma, Loss of respect of peer 2. economic/cost implications 3. Physical consequences 4. Emotional/psychological issues/concerns

II. Inability to make decisions with respect to taking appropriate health action due to:
A. B. C. D. E. F. G. H. I. Failure to comprehend the nature/magnitude of the problem/condition Feeling of confusion, helplessness and resignation brought about by perceived magnitude/severity of the situation Lack of/Inadequate knowledge/insight as to alternative courses of action open to them Inability to decide which action to take from among list of alternatives Conflicting opinions among family members regarding action to take Lack of/Inadequate knowledge of community resources of care Fear of consequences of action Negative attitude toward the health condition Inaccessibility of appropriate resources for care

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

B. Lack of knowledge about child development C. Lack of knowledge of the nature and extent of nursing care needed. D. Lack of facilities E. Altered role performance Role denial Role strain Role dissatisfaction Role conflict Role confusion Role overload

 III. Inability to provide a home environment conducive to health maintenance and personal development due to : A. Lack of knowledge of importance of hygiene and sanitation B. Lack of supportive relationship among family members C. Inadequate family resources D. Lack of/Inadequate knowledge of importance of hygiene and sanitation E. Lack of skill in carrying out measures to improve home envt F. Ineffective communication patterns within the family G. Lack of supportive relationship among family members H. Negative attitude/philosophy in life which is not conducive to health maintenance and personal development.

IV. Failure to utilize community resources for health care due to:
A. Lack of/Inadequate knowledge of community resources for health care B. Lack of trust/confidence in the agency/personnel C. Failure to perceive the benefits of health care/services D. Previous unpleasant experience with health worker E. Unavailability of required care/service F. Inaccessibility of required care/service due to cost constraints or physical inaccessibility G. Lack of adequate family resources H. Negative attitude/philosophy in life which hinders effective utilization of community resources for health care I. Feeling of alienation to/lack of support from the community

DATA COLLECTION First-level-Data on Status condition of: Family/household members Home and Environment Second Level- Data Familys assumption Of health condition/ Problem identified Methods/Sources: 1st level assessment Health Status of the Family Health assessment Laboratory Records/reports

-Recognize Need to use data based on evidence -Ensure accuracy and reliability of data -Check for inconsistencies -Complete missing information HEALTH CONDITIONS/ PROBLEMS AND FAMILY NURSING DIAGNOSIS -First- level assessment: Define the health Conditions/ problems (categorized as: Wellness states, health deficits, health Threats, foreseeable crises or stress points) Second- level assessment: Define the family nursing problems/ Diagnosis (table 3) as statements of:

DATA ANALYSIS
-Sort data -Cluster/ group related data -Distinguish relevant from irrelevant data -Identify patterns (e.g. function, behavior lifestyle) -Compare patterns with norms or standards -Interpret results -Make inferences/ draw conclusions

Home and Environment Observation/Ocular survey Interview Dx Test Records/reports Second Level Assessment: In-Depth Interview on realities Perception about and attitudes Towards performance of task Observe: Relate verbal with nonverbal

Familys inability to perform Health Tasks on each Health Condition/ Problem specifying the barriers to performance or reasons for non- performance of Family Health task

Continuous Data Validation/ Update for Adequacy of Evidence to Support Diagnosis