Chapter 2 Nursing Assessment in Family Nursing Practice Araceli S. Maglaya DEFINITION AND CONCEPTS Nursing assessment is the first major phase of the nursing pro- cess. sp sey health nursing practice, this 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, and its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well-being among its members. Data about the present con- dition or status of the family are compared against norms or standards of personal, social and environmental health, system integrity and ability to resolve system problems. These norms or standards are derived from values, beliefs, principles, rules or expectations (Tumer 1974, p. 17). Nursing assessment includes data collection, data analysis or in- terpretation and problem definition or nursing diagnosis. Nursing diagno- sis is the end result of two major types of nursing assessment in family nursing practice based on the framework used in this book. These are: (1) firstlevel assessment; (2) second-level assessment. Operationally defined, first-level assessment is a process whereby existing and poten- tial health conditions or problems of the family are determined. These health conditions or problems are categorized as: (1) wellness state/s; (2) health threats; (3) health deficits, and (4) stress points or foresee- able crisis situations (see Table 3). Second-tevel assessment, on the other hand, defines 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 assump- tion of these tasks. These two levels of assessment specify a hierarchy of two sets of data and their analyses. They reflect depth of data gathering and analysis on what health ‘conditions or problems exist (first-level assess- ment), and why each health condition or problem related with maintain- ing wellness exists. The latter are stated as explanations about the family’s problems related to maintaining wellness and/or provide a home 54environment conducive to health maintenance and personal development (second-level assessment), STEPS IN FAMILY NURSING ASSESSMENT There are three major steps in nursing assessment as applied to _ family nursing practice. Figure 1 illustrates these steps. Data collection for first level assessment involves gathering of five ‘types of data which will generate the categories of health conditions or problems of the family. These data include: Family structure, characteristics and dynamics; Socio-economic and cultural characteristics; Home and environment; Health status of each member; and Values and practices on health promotion/maintenance and disease prevention. geene Second-level assessment data include those that specify or de- ibe the family’s realities, perceptions about and attitudes related to the mption or performance of family health tasks on each health condi- ‘or problem identified during the first level assessment. Data analysis involves several sub-steps: (1) Sorting of data for categories such as those related with the health status or prac- of family members or data about home and environment; (2) Clus- Of related cues to determine relationships between and among data; Distinguishing relevant from irrelevant data to decide what informa- is pertinent to understanding the situation at hand and what infor- is immaterial, (4) Identifying pattems such as physiologic function, opmental, nutritional/dietary, coping/adaptation or communication ms and lifestyle; (5) Comparing pattems with norms or standards ith, family functioning and assumption of health tasks; (6) Inter- results of comparisons to determine signs, symptoms or cues of weliness state/s, health deficil/s, health threat/s or foreseeable point/s and their underlying causes or associated factors; and Making inferences or drawing conclusions about the reasons for the \ce of the health condition, problem, risk factor/s related to non- nance of wellness state/s which can be attributed to non- ance of family health tasks. 55+ ¢ DATA COLLECTION ]-»1 DATA ANALYSIS Framework: Use an Organized ‘and Comprehensive Approach to Assessment First-level - Data on Status! Condition of: + Family/Household Members + Home and Environment Second-level - Data on imily’s Assumption of Health © on each Health Condition! Problem idk in first-level assessment Methods / Sources: Firstlevel Assessment (Table 2): ‘Health Status of Family! Household Member: ‘© Health Assessment © Laboratory! Diagnostic Test Results © Records/Reports Home and Environment J Interview ‘© Laboratory/Diagnostic Test Results ‘© Records/Reports ‘econd-level Assessment: In-depth Interview on Realities/Perceptions about Attitudes towards ‘Assumption! Performance of Health Tasks Observation: Relate Verbal with Non-verbal Cues + Sort Data + Cluster/Group Related Data + Distinguish Relevant from Irrelevant Data + Identify Patterns (eg., function, behavior, lifestyle) + Compare Patterns with Norms or Standards + Interpret Results + Make Inferences/ Draw Conclusions + Recognize Need to Use Data based on Evidence + Ensure Accuracy and Reliability of Data + Check for Inconsistencies + Complete Missing Information L HEALTH CONDITIONS / PROBLEMS AND FAMILY NURSING DIAGNOSES First-level Assessment: Define the Health Conditions / Problems (categorized as: wellness states, health deficits, health threats, foreseeable crises or stress. points) Second-level Assess- ment: Define the Family Nursing Problems/ Diagnoses (Table 3) as Statements of: Family's Inability to Perform Health Tasks on each Health Condition / Problem specifying the Barriers to Performance or Reasons for Non-performance of Family Health » t juous Data Validation/Update for Tasks t Adequacy of Evidence to Support Diagnosi Figure 1. The Assessment Phase in Family Health Nursing Practice: The Critical Thinking Approach