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- involves a set of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a system and functioning unit, its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well-being among its members. Nursing Assessment includes: Data collection Data analysis or interpretation Problem definition or nursing diagnosis – end result of two major types of nursing assessment in family health nursing practice. First Level Assessment -is a process whereby existing and potential health conditions or problems of the family are determined.
Category of Health conditions/Problems: Wellness state/s Health Threats Health deficits Stress points or foreseeable crisis situations 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 family’s assumption of the tasks. Steps in Family Nursing Assessment 1.Data Collection – gathering of five types of data which will generate the categories of health conditions or problems of the family. a.) family structure, characteristics & dynamics – include the composition and demographic data of the members of the family/household, their relationship to the head and place of residence; the type of, and family interaction/communication and decision-making patterns and dynamics.
b.) socio-economic & cultural characteristics – include occupation, place of work, and income of each working member; educational attainment of each family member; ethnic background and religious affiliation; significant others and the other role(s) they play in the family’s life; and, the relationship of the family to the larger community. c.) home and environment – include information on housing and sanitation facilities; kind of neighborhood and availability of social, health, communication and transportation facilities in the community. d.)health status of each member – includes current and past significant illness; beliefs and practices conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/diagnostic tests/screening procedures.
e.) values and practices on health promotion/maintenance & disease prevention – include use of preventive services; adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities, and immunization status of at-risk family members. Data Gathering Methods & Tools a.)Observation – method of data collection through the use of sensory capacities --sight, hearing, smell and touch. Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers. b.) Physical Examination – done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing the body systems.
c.) Interview – completing the health history of each family member. The health history determines current health status based on significant past health history. The second type of interview is collecting data by personally asking significant family members or relatives questions regarding health, family life experiences and home environment to generate data on what wellness condition and health problems exist in the family. Productivity of the interview process depends upon the use of effective communication techniques to elicit the needed responses. • Second level assessment can be adequately done for each wellness state, health threat, health deficit or crisis situation by going through the following procedures: 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 reasons 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 problem or condition, determine if the solution is effective.
Determine if the family encounters other problems in implementing interventions for the wellness state/potential, health threat, health deficit or crisis. What are these problems?
Determine how all the other members are affected by the wellness state/potential, health threat deficit or stress point.
d.) Record Review – reviewing existing records and reports pertinent to the client. ( individual clinical records of the family members; laboratory & diagnostic reports; immunization records; reports about the home & environmental conditions. e.) Laboratory/Diagnostic Tests – performing laboratory tests, diagnostic procedures or other tests of integrity and functions carried out by the nurse herself and/or other health workers. 2. Data Analysis - sort data - cluster/group related date - distinguish relevant from irrelevant data - identify patterns - compare patterns with norms or standards - interpret results - make inferences/draw conclusions
3. Nursing Diagnoses: Family Nursing Problems * 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 FAMILY NURSING 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. FIRST- LEVEL ASSESSMENT I. PRESENCE OF WELLNESS CONDITION – stated as Potential or Readiness
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. III. PRESENCE OF HEALTH DEFICITS – instances of failure in health maintenance. IV. PRESENCE OF STRESS POINTS/FORESEEABLE CRISIS SITUATIONS – anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. SECOND-LEVEL ASSESSMENT I. Inability to recognize the presence of the condition or problem. II. Inability to make decisions with respect to taking appropriate health action. III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family.
IV. Inability to provide a home environment conducive to health maintenance and personal development. V. Failure to utilize community resources for health care.
DEVELOPING THE NURSING CARE PLAN THE FAMILY CARE PLAN – is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care ( goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria, standards, methods and tools.
DESIRABLE QUALITIES OF A NURSING CARE PLAN 1.It should be based on clear, explicit definition of the problems. A good nursing plan is based on a comprehensive analysis of the problem situation. 2.A good plan is realistic. 3.The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and evaluating outcomes. 4.The nursing care plan is most useful in written form. THE IMPORTANCE OF PLANNING CARE 1.They individualize care to clients. 2.The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems.
3.The nursing care plan promotes systematic communication among those involved in the health care effort. 4.Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the services provided are minimized, if not totally eliminated. 5.Nursing care plans, facilitate the coordination of care by making known to other members of the health team what the nurse is doing. STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN 1.The prioritized condition/s or problems based on: - nature of condition or problem - modifiability - preventive potential - salience 2.The goals and objectives of nursing care. Expected Outcomes: - conditions to be observed to show problem is prevented, controlled, resolved or eliminated. - Client response/s or behavior
> Specific, Measurable, Clientcentered Statements/Competencies 3.The plan of interventions. Decide on: - Measures to help family eliminate: . barriers to performance of health tasks . underlying cause/s of nonperformance of health tasks - Family-centered alternatives to recognize/detect, monitor, control or manage health condition or problems - Determine Methods of Nurse-Family Contact - Specify Resources Needed 4.The plan for evaluating. - Criteria/Outcomes Based on Objectives of Care - Methods/Tools
COMMUNITY DIAGNOSIS TYPES OF COMMUNITY DIAGNOSIS 1.COMPREHENSIVE COMMUNITY DIAGNOSIS – aims to obtain a general information about the community. A.Demographic Variables B.Socio-Economic and Cultural Variables C.Health and Illness Patterns D.Health resources E.Political/Leadership Patterns 2.PROBLEM-ORIENTED COMMUNITY DIAGNOSIS – type of assessment that responds to a particular need. PROCESS OF COMMUNITY DIAGNOSIS: Collecting Organizing Synthesizing Analyzing and interpreting health data
STEPS IN CONDUCTING COMMUNITY DIAGNOSIS 1.DETERMINING THE OBJECTIVES – the nurse decides on the depth and scope of the data she needs to gather. 2.DEFINING THE STUDY POPULATION – the nurse identifies the population group to be included in the study. 3.DETERMINING THE DATA TO BE COLLECTED – the objectives will guide the nurse in identifying the specific data she will collect, and will also decide on the sources of these data. 4.COLLECTING THE DATA – the nurse decides on the specific methods depending on the type of data to be generated. 5.DEVELOPING THE INSTRUMENT – instruments/tools facilitate the nurse’s data-gathering activities. Most common instruments: - survey questionnaire - interview guide - observation checklist
6.ACTUAL DATA GATHERING – the nurse supervises the data collectors by checking the filled-up instruments in terms of completeness, accuracy and reliability of the information collected. 7.DATA COLLATION – the nurse is now ready to put together all the information. 8.DATA PRESENTATION – will depend largely on the type of data obtained. (descriptive & numerical data) 9.DATA ANALYSIS – aims to establish trends and patterns in terms of health needs and problems of the community. 10.IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS Health status problems – increased or decreased morbidity, mortality, fertility or reduced capability for wellness. Health resources problems – lack of or absence of manpower, money, materials or institutions necessary to solve health problems. Health-related problems – existence of social, economic, environmental and political factors that aggravate
the illness-inducing situations in the community. 11.PRIORITY-SETTING – prioritize which health problems can be attended to considering the resources available at the moment.
CRITERIA Nature of the Problem Health status 3 Health resources 2 Health-related 1 Magnitude of the problem 75% - 100% affected 4 50% - 74% affected 3 25% - 49% affected 2 <25% affected 1 Modifiability of the problem High 3 Moderate 2 Low 1 Not Modifiable 0 Preventive potential High 3 Moderate 2 Low 1 Social Concern Urgent community concern; expressed readiness recognized as a problem but not needing urgent attention not a community concern WEIGHT 1 3
1 2 1 0
• Nature of the condition/problem presented – problems classified by the nurse as health status, health resources or health-related problems. • Magnitude of the problem – refers to the severity of the problem which can be measured in terms of the proportion of the population affected by the problem. • Modifiability of the problem – probability of reducing, controlling or eradicating the problem. • Preventive potential – probability of controlling or reducing the effects posed by the problem. • Social concern – perception of the population or the community as they are affected by the problem and their readiness to act on the problem. WHAT IS PLANNING? PLANNING – is a process that entails formulation of steps to be undertaken in the future in order to achieve a desired end.
Concepts of Planning: . Planning is futuristic. . Planning is change-oriented. . Planning is a continuous and dynamic process. . Planning is flexible. . Planning is a systematic process. THE PLANNING CYCLE: 1.Situational Analysis - gather health data - tabulate, analyze and interpret data - identify health problems - set priority 2.Goal and Objective Setting - define program goals and objectives - assign priorities among objectives 3.Strategy/Activity Setting - Design CHN Program - Ascertain resources - Analyze constraints and limitations 5.Evaluation - determines outcomes - specify criteria and standards
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