CHN P17

2. Medical or nursing diagnosls Indicating current health status of each family member;

. Conditlon of home and environment conducive to disease/illness or accldents;

4. Maturation/developmental or situational crisis situations.

the second level of analysls ends with a definition of family nursing problems. To define famly nursing

problems, each wellness state or health condition or problem must be analyzed in terms of how the

famly handles it. The processed of data gathering has been described earlier (Data-gathering Methods

and Tools). The patterns and implications of these data reflect explanations and inferences about the

family as a functioning unit in terms of its problems related to performance of family health task. The

causes of or the reasons for the existence of the condition or health condition or problem reflect

bariers to the family's capabltes to promote and maintaln health among its members as t maintains

family system integrity.

NURSTNG DIAGNOSES: FAMILY NURSING PROBLEMS

The end result of the second level assessment is a set of family nursing problems for each health

condition or problem.

Wellness condition is a nursing judgment related with the clent's capablity for weliness. A health

condition or problem is a situation which interferes with the promotion or maintenance of health and

recovery from illness or injury. A wellness state or health condition/problem becomesa family nursing

problem when it is stated as the family's failure to perform adequately specific health tasks to enhance

or sustain the weliness state or manage the health problem. This is called the nursing diagnosis in

family nursing practice, specifically defined as a dinical judgment about the family's response to actual

or potential health problems or life processes (North American Nursing Diagnosis Association [NANDA]

2001).

To facilitate the process of defining family nursing problems, a classification system of family nursing

problems was developed and field tested in 1978. This tool called A Typology of Nursing Problems
in Family Nursing Practice, has been used by nursing students, community health nurse

practitioners and educators. Through the years revisions has been done to ensure all-inclusiveness and

mutual exclusiveness of the list. In 2003, presence of wellness condition has been added in the first-

level assessment part of the typology.

THE TYPOLOGY OF NURSING PROBLEMS IN FAMILY HEALTH CARE

The rationale for adopting these health tasks as the framework of the typology is the fact that in

Community health nursing practice, the nurse deais mostly with problems within the domain of human

behavior or human response to health and illness. It is not very often that the community health nurse

deals with the physical, psychological, or clinical condition of the patient requiring her sustained direct

services such as nursing care during the acute phase of an illness in the hospital setting. Much of the

nurse's efforts are directed at effecting change in the behavior of the clients to achieve optimum health.

Community health nurse works with and through the family to improve its capability to achieve health

and wellness among its members.

The typology contains six main categories of problems in the family nursing care. The first category

refers to the presence of wellness states, health threats, health deficits and foreseeable crisis situations

or stress points. The result of the analysis of data taken during the first-level assessment (utiliz the

tool Assessment Data Base for Family Nursing) is reflected as statement of the health condition or

problem, a wellness state, health threat, health deficit or foreseeable crisis/stress point. After
identifying

these health conditions or problems, the nurse determines the family's ability to perform the five health

tasks on each one. The remaining five main categorles of problems contain statements of the family's

inability to perform the health tasks. The results of the analysis of data taken during the second-level

assessment are reflected as statements of the family nursing problems. There are five main types,

namely

1. Inability to recognize the presence of the condition/problem due to...

2. Inability to make decisions with respect to taking appropriate health action due to...
3. Inability to provide nursing care to the sick, disabled, dependent or at-risk member of the

family due to...

4. Inability to provide a home environment which Is conduclve to health malntenance and personal

development due to..

5. Failure to utilize community resources for the health care due to..

The categorization of problems in the typology constitutes several levels according to the degree of

generality or specificity, After each main category of familly nursing problem, several more specific

problems are identified reflecting contributory problems to or explanations for the existence of the main

problem. This is parallel to the concept of immediate cause, Intermedlate cause and ultimate cause

when identifying the cause(s) of morbidity and mortality, or Mundinger and Jauron's concept of a

nursing diagnosis (Mundinger and Jauron 1975. Pp. 96-97). According to the latter, a nursing diagnosis

consists of two parts: