TABLE 3. A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE* FIRST-LEVEL ASSESSMENT |. 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 client's performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client's current competencies or performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. Examples of these are the following: A. Potential for Enhanced Capability for: 1. Healthy Lifestyle — e.g. nutrition/diet, exercise/activity 2. Health Maintenance/Health Management 3, Parenting 4. Breastfeeding 5. Spiritual Well-being — process of a client's developing/ unfolding of mystery through harmonious interconnectedness that comes from inner strength/sacred source/God (NANDA 2001) 6. Others, specify: B. Readiness for Enhanced Capability for: . Healthy Lifestyle Health Maintenance/Health Management Parenting Breastfeeding Spiritual Well-being Others, specify: PRES we ll. Presence of Health Threats - conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. Examples of these are the following: A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome) B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide * Developed and published by Salvacion G. Bailon-Reyes and Araceli S. Maglaya in 1978 (see Ballon SG and Maglaya AS: Family Health Nursing - The Process, Printing 4. Manila, Brainchild Managers and Consultants, 1990); reviewed and updated in 1994, 1997and 2003 by A.S.Maglaya.D. Accident hazards. specify: 1. broken stairs 2. pointed/sharp objects, poisons, and medicines improperly kept 3. fire hazards 4. fall hazards 5. others (specify): E. Faulty/unhealthful nutritional/eating habits or feeding techniques practices. Specify: 1. inadequate food intake both in quality and quantity 2. excessive intake of certain nutrients 3. faulty eating habits 4. ineffective breastfeeding 5. faulty feeding techniques F. — Stress-provoking factors — specify: 1. strained marital relationship 2. strained parent-sibling relationship . 3. interpersonal conflicts between family members 4. care-giving burden G. Poor home/environmental condition/sanitation — specify: inadequate living space . lack of food storage facilities . polluted water supply . presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, flies, roaches, rodents, etc.) . improper garbage/refuse disposal unsanitary waste disposal improper drainage system poor lighting and ventilation noise pollution 10. air pollution H. Unsanitary food handling and preparation |. Unhealthful lifestyle and personal habits/practices - specify: . alcohol drinking . cigarette/tobacco smoking walking barefooted or inadequate footwear . eating raw meat or fish poor personal hygiene self-medication/substance abuse sexual promiscuity . engaging in dangerous sports . inadequate rest or sleep . lack offinadequate exercise/physical activity . lack offinadequate relaxation activities RoONa {0D SSeenogaona (more next page)oO. 2 2. AS 12. non-use of self-protection measures (e.g. non-use of bednets in malaria and filariasis endemic areas) Inherent personal characteristics — e.g. poor impulse control Health history which may participate/induce the occurrence of a health deficit, e.g. previous history of difficult labor Inappropriate role assumption — e.g. child assuming mother's role, father not assuming his role Lack of immunization/inadequate immunization status specially of children Family disunity — e.g. 4. self-oriented behavior of member(s) 2. unresolved conflicts of member(s) 3. intolerable disagreement Others, specify: Presence of Health Deficits — instances of failure in health maintenance. Examples include: A. B. c. Illness states, regardless of whether it is diagnosed or undiagnosed by medical practitioner Failure to thrive/develop according to normal rate Disability — whether congenital or arising from illness; transient / temporary (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation secondary to diabetes, blindness from measles, lameness from polio) Presence of Stress Points/Foreseeable Crisis Situations — anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. Examples of these include: ozzracHrommoop> Marriage Pregnancy , labor, puerperium Parenthood Additional member — e.g. newborn, lodger Abortion Entrance at school Adolescence Divorce or separation Menopause Loss of Job Hospitalization of a family member Death of a member Resettlement in a new community Megitimacy Others, specify3ECOND-LEVEL ASSESSMENT 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 conse- quences of diagnosis of problem, specifically: 4. social-stigma, loss of respect of peer/significant others 2. economic/cost implications 3. physical consequences 4. emotional/psychological issues/concerns C. Attitude/philosophy in life which hinders re¢ognition/acceptance of problem Gam Pro. 4 D. Others, specify Y Ai Ao Dra IMI pb fy Inability to make decisions with respect to taking appropriate health ac- tion due to: A. Failure to comprehend the nature/magnitude of the problem/condi- tion B. Low salience of the problem/condition C. Feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/severity of the situation or problem, i.e., fail- ure to break down problems into manageable units of attack . Lack offinadequate knowledge/insight as to alternative courses of ac- tion open to them . Inability to decide which action to take from among a list of alter- natives Conflicting opinions among family members/significant others regard- ing action to take . Lack offinadequate knowledge of community resources for care |. Fear of consequences of action, specifically: 1. social consequences 2. economic consequences 3. physical consequences 4. emotional/psychological consequences |. Negative attitude towards the health condition or problem -By nega- tive attitude is meant one that interferes with rational decision mak- fo nom oO ing J. Inaccessibility of appropriate resources for care, specifically: 1. physical inaccessibility 2. cost constraints or economic/financial inaccessibility K. Lack of trust/confidence in the health personnel/agency L! Misconceptions or erroneous information about proposed course(s) of action M. Others, specify Inability to provide adequate nursing care to the sick, disabled, depen- dent or vulnerable/at-risk member of the family due to: A. Lack offinadequate knowledge about the disease/nealth condition (nature, severity, complications, prognosis and management); B. Lack offinadeauate knowledae about child development and careC. Lack offinadequate knowledge of the nature and extent of nursing care needed 2 . Lack of the necessary facilities, equipment and supplies for care . Lack of or inadequate knowledge and skill in carrying out the nec- essary interventions/treatment/procedure/care (@.9., complex thera- peutic regimen or healthy lifestyle program) F. Inadequate family resources for care, specifically: 4. absence of responsible member 2. financial constraints 3. limitations/lack of physical resources - e.g., isolation room G. Significant person’s unexpressed feelings (e.9., hostility/anger, guilt, fear/anxiety, despair, rejection) which disable his/her capacities to provide care. H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at-risk member |. Member's preoccupation with own concerns/interests J. Prolonged disease or disability progression which exhausts support- ive capacity of family members K. Altered role performance - specify: 4) role denial or ambivalence 2) role strain 3) role dissatisfaction 4) role conflict 5) role confusion 6) role overload L. Others, specify mo IK Inability to provide a home environment conducive to health maintenance and personal development due to: A. Inadequate family resources, specifically: 1. financial constraints/limited financial resources 2. limited physical resources — e.g. lack of space to construct fa- cility . Failure to see benefits (specifically long-term ones) of investment in home environment improvement . Lack offinadequate knowledge of importance of hygiene and sani- tation . Lack offinadequate knowledge of preventive measures Lack of skill in carrying out measures to improve home environ- ment Ineffective communication patterns within the family . Lack of supportive relationship among family members H. Negative attitude/philosophy in life which is not conducive to health maintenance and personal development mo oO @ one wL Lack offinadequate competencies in relating to each other for mutual growth and maturation (e.g. reduced ability to meet the physical and psychological needs of other members as a re- sult of family’s preoccupation with current problem or condi- tion) Others, specify IV. Failure to utilize community resources for health care due to: A. moon on Lack offinadequate knowledge of community resources for health care Failure to perceive the benefits of health care/services Lack of trust/confidence in the agency/personnel Previous unpleasant experience with health worker Fear of consequences of action (preventive, diagnostic, thera- peutic rehabilitative), specifically: 1. physical/psychological consequences 2. financial consequences 3. social consequences -e.g., loss of esteem of peer/signifi- cant others Unavailability of required care/service Inaccessibility of required care/service due to: 1. cost constraints 2. physical inaccessibility, i.e. location of facility Lack of or inadequate family resources, specifically: 1. manpower resources -e.g., baby sitter 2. financial resources -e.g., cost of medicine prescribed Feeling of alienation to/lack of support from the community, e.g., stigma due to mental illness, AIDS, etc. Negative attitude/philosophy in life which hinders effective/maxi- mum__ utilization of community resources for health care Others, specify afb biel