FAMILY HEALTH NURSING PRACTICE

TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

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(Copied from Maglaya, A. Nursing Practice in the Community, 5 Ed, 2009 pp 67-72)

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FIRST-LEVEL ASSESSMENT (GUIDE TO WELLNESS CONDITIONS AND FAMILY HEALTH PROBLEMS)

I. Presence of Wellness Condition – stated as potential or readiness – a clinical nursing g judgment about a client in transition from a specific level of wellness
or capability to a higher level (NANDA, 2001). Examples of these are the following:

A. Potential for Enhanced Capability for: (… nursing judgment on wellness state or condition based on client’s performance, current competencies
or clinical data but no explicit expression of client desire.

1. Healthy life-style – e.g. nutrition / diet, exercise / activity

2. Health maintenance / health management
3. Parenting
4. Breastfeeding
5. Spiritual well being – process of 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: (…nursing judgment on wellness state or condition based on client’s 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.

1. Healthy life style

2. Health maintenance / health management
3. Parenting
4. Breastfeeding
5. Spiritual well being
6. Others, specify: ______________________

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.
Examples of these are the following:

1) Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
2) Threat of cross-infection from a communicable disease case
3) Family size beyond what family resources can adequately provide
4) Accident hazards: examples
1. Broken stairs
2. Pointed/sharp objects, poisons, and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others, specify: _____________________
5) Faulty / unhealthful nutritional/eating habits or feeding techniques or 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 practices
6) Stress-provoking factors – specify:
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
7) Poor home/environmental condition/sanitation – specify:
1. Inadequate living space
2. Lack of food storage facilities
3. Polluted water supply
4. Presence of breeding or resting sites of vectors of diseases (e.g. mosquitoes, flies, roaches, rodents, etc.)
5. Improper garbage/refuse disposal
6. Improper drainage system
7. Poor lighting and ventilation
8. Noise pollution
9. Air pollution
8) Unsanitary food handling and preparation
9) Unhealthful lifestyle and personal habits/practices – specify:
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefoot or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self-medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of/inadequate exercise/physical activity
11. Lack of/inadequate relaxation activities
 12. Non-use of self-protection measures (e.g. non-use of bednets in malaria and filariasis endemic areas)
10) Inherent personal characteristics – e.g. poor impulse control
11) Health history which may precipitate/induce the occurrence of a health deficit, e.g. history of difficult labor
12) Inappropriate role assumption – e.g. child assuming mother’s role, father not assuming his role
13) Lack of immunization/inadequate immunization status specially of children
14) Family disunity – examples:
1. Self-oriented behavior of member (s)
2. Unresolved conflict of member (s)
3. Intolerable disagreement
15) Others, specify: _______________________________

III. Presence of Health Deficits – instances of failure in health maintenance. Examples include:
A) Illness states, regardless of whether diagnosed or undiagnosed by a medical practitioner
B) Failure to thrive/develop according to normal rate
C) Disability – whether congenital or arising from illness, transient or 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)

IIII. Presence of Stress Points / Foreseeable Crisis Situations – anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources, transitions (i.e. passage from one life phase, condition or status to another, causing a forced or chosen change that results in the
need to construct a new reality). Examples of these include
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member – e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Chronic illness
K. Loss of job
L. Hospitalization of a family member
M. Death of a member
N. Resettlement in a new community
O. Illegitimacy
P. Others, specify

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 Handout 3: FAMILY HEALTH NURSING PRACTICE
TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE
(Copied From Maglaya, A. Nursing Practice in the Community, 2009, pp 70-72(

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SECOND LEVEL ASSESSMENT (LIST OF FAMILY NURSING DIAGNOSES)

I. INABILITY TO RECOGNIZE THE PRESENCE OF THE CONDITION OR THE PROBLEM RELATED 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:
1. 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 recognition/acceptance of a problem
D. Others, specify ___________________________
II. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING APPROPRIATE HEALTH ACTION RELATED 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 perceived magnitude or 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:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem – negative attitude means one that interferes with rational decision making
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 ___________________________
III. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE SICK, DISABLED, DEPENDENT OR VULNERABLE/AT RISK
MEMBER OF THE FAMILY RELATED 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 and extent of nursing care needed
D. Lack of the necessary facilities, equipment and supplies for care
E. Lack of or inadequate knowledge and skill in carrying out the necessary interventions /treatment/procedure/care (e.g. complex therapeutic
regimen of healthy lifestyle program)

F. Inadequate family resources for care, specifically

1. Absence of a responsible family member
2. Financial constraints
3. Limitations/lack of physical resources – e.g. isolation room
G. Significant person’s unexpressed feelings (e.g. hostility/anger, guilt, fear, anxiety, despair, rejection) which affect his/her capacity to provide care
H. Philosophy in life which negates/hinders caring for the sick, disabled, dependent, vulnerable/at risk member
I. Member’s preoccupation with own concerns/interests
J. Prolonged disease or disability progression which exhausts supportive capacity of family members
K. Altered role performance – specify:
1. Role denial or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role overload
L. Others, specify ___________________________
IIII. INABILITY TO PROVIDE A HOME ENVIRONMENT CONDUCIVE TO HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT
RELATED TO:

A. Inadequate family resources, specifically:

1. Financial constraints/limited financial resources
2. Limited physical resources – e.g. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investment in home environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
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
 I. Lack of/inadequate 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 result of family’s preoccupation with current problem or condition)

J. Others, specify ________________________________

V. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE RELATED 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
E. Fear of consequences of action (preventive, diagnostic, therapeutic, rehabilitative), specifically:
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences – (e.g. loss of esteem of peer/significant others)
F. Unavailability of required care/service
G. Inaccessibility or required care/service due to:
1. Cost constraints
2. Physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically
1. Manpower resources – e.g. baby sitter
2. Financial resources – e.g. cost of medicines prescribed
I. Feeling of alienation to/lack of support from the community, e.g. stigma due to mental illness, AIDS, etc.
J. Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care
K. Others, specify _______________________________
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