HEALTH CARE PROCESS

- is a process utilized to systematize the helping process extended to the clients

- basically it is the use of scientific method of exploring and analysing data to arrive at
logical conclusions and rational solutions to problems
PHASES OF HEALTH CARE PROCESS
I. ASSESSMENT
- Collection and analysis of factual information relevant to client’s status, his capacity to
solve health problems and his environment
- The following are resources of data in assessment:

A. HEALTH STATUS OF THE FAMILY MEMBERS

1. Analyses of data taken from this source reflect deviations in health development of
individuals.
2. Nurse needs adequate skills in determining deviations in physical and psychosocial
aspects of a person’s health.
3. Broad knowledge based on the socio-cultural variables affecting health, illness and
help-seeking behaviours.

B. FAMILY’S STRUCTURE AS A FUNCTIONING UNIT EXPECTED TO

PROMOTE WELLNESS AMONG ITS MEMBERS
1. Analyses of data taken from this source reflect the nature and extent of the family’s
performance of specific health tasks to meet the physical, social and emotional
needs of its members.
2. Nurse needs knowledge on group processes, family role relationships, and family
decision-making and family communication patterns.

C. FAMILY ENVIRONMENT
1. Home and the community.
2. Knowledge-based required for an adequate assessment of physical and socio-
cultural threats to health and development.

II. INTERVENTION
- This is where planning and putting plans to actions are done
- The phase where the nurse formulates the following:
a. Goals
b. Objectives
c. Nursing Actions

III. EVALUATION
- Done to demonstrate whether or not the intended results did occur.
TWO TYPES OF DATA
1. FIRST LEVEL ASSESSMENT- content of the initial data base.
2. SECOND LEVEL ASSESSMENT – reflects the extent to which the family can perform the
health task on each health threat, health deficit and stress point.

FAMILY HEALTH TASKS ACCORDING TO FREEMAN

1. Recognizing interruptions of health development- refers to the family’s ability to recognize the
presence of a health problem.
2. Making decisions about taking appropriate health actions.
3. Providing nursing care to the sick, disabled, and/or dependent members of the family.
4. Maintaining a home environment conducive to health maintenance and personal development.
5. Maintaining a reciprocal relationship with the community and its health institutions- implies
effective utilization of community resources for health care.

METHODS OF GATHERING DATA

1. Direct observation
2. Interviewing
3. Other methods- include review existing records and reports pertinent to the client.

e.g. clinical records of family members’ immunization

SEQUENCE OF ACTIVITIES IN FAMILY NURSING PRACTICE

I. ESTABLISHES A WORKING RELATIONSHIP WITH THE FAMILY
II. CONDUCTS AN INITIAL ASSESSMENT TO DETERMINE THE PRESENCE OF
ANY HEALTH PROBLEM
III. CATEGORIZES HEALTH PROBLEMS
IV. DETERMINE THE NATURE AND EXTENT OF THE FAMILY’S
PERFORMANCE OF THE HEALTH TASKS ON EACH OF THE HEALTH
PROBLEMS CATEGORIZED IN NO.3
V. DETERMINE PRIORITIES AMONG THE LIST OF HEALTH PROBLEMS
VI. RANK THE HEALTH PROBLEMS ACCORDING TO PRIORITIES
VII. DECIDE ON WHAT PROBLEMS TO TACKLE IN THE ORDER OR
IMMEDIACY/URGENCY, BASED ON PRIORITIES SET
VIII. DEFINES NURSING OBJECTIVES (SMART) JOINTLY WITH THE FAMILY
IX. PLANS APPROACHES, STRATEGIES OF ACTION CRITERIA AND
STANDARDS FOR EVALUATION
X. IMPLEMENTS PLAN OF CARE
 XI. EVALUATES THE EFFECTIVITY OF IMPLEMENTED ASPECTS OF THE
PLAN
XII. REDEFINES NURSING PROBLES AND REFORMULATES OBJECTIVES
ACCORING TO EVALUATION FINDINGS

SEQUENCE OF ACTIIVIES IN FAMILY NURSING PRACTICE

I. ESTABLISHES A WORKING RELATIONSHIP WITH THE FAMILY
a. Initiates contact
b. Communicates interest in the family’s welfare
c. Express/show willingness to help with expressed needs
d. Maintains a two-way communication with the family

II. CONDUCTS AN INITIAL ASSESSMENT TO DETERMINE THE PRESENCE OF

ANY HEALTH PROBLEM

TOOL: INITIAL DATA BASE (first level assessment data)

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. FAMILY STRUCTURE AND CHARACTERISTICS

1. Members of the household and relationship to the head of the family
2. Demographic data- age, sex, civil status, position in the family
3. Place of residence of each member- whether living with family or
elsewhere
4. Type of family structure- matriarchal, patriarchal, nuclear, extended
5. Dominant family members in terms of decision-making in matters of
health care
6. General family relationship

B. SOCIO-ECONOMIC AND CULTURAL FACTORS

1. Income and expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities
c. Who makes decisions about the money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant others
5. Relationship of the family to a larger community
 C. ENVIRONMENTAL FACTORS
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Adequacy of furniture
d. Presence of insects and rodents
e. Presence of accident hazards
f. Food Storage and cooking facilities
g. Water supply- source, ownership, potability
h. Toilet facility- type, sanitary condition
i. Garbage disposal- type, sanitary condition
j. Drainage system- type, sanitary condition
2. Kind of neighbourhood
3. Social and health facilities available
4. Communication and transportation facilities available

D. HEALTH ASSESSMENT OF EACH MEMBER

1. Medical and Nursing history including past significant illnesses, beliefs
and practices
2. Nutritional assessment
a. Anthropometric- height weight, mid-arm circumference
b. Dietary history indicating quality and quantity of food intake per day
c. Eating/feeding habits or practices
3. Current health status indicating presence of illness state

E. VALUE PLACED ON PREVENTION OF DISEASE

1. Immunization status of children
2. Use of other preventive services

III. CATEGORIZES HEALTH PROBLEMS

TOOL: TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING
PRACTICE: FIRST LEVEL ASSESSMENT
A. HEALTH THREAT
-conditions that are conducive to disease, accident or failure to realize one’s health
potential
1. Health history of specific condition/disease- e.g. family history of diabetes
2. Threat of cross-infection from communicable disease case
3. Family size beyond what family resources can adequately provide
4. Accidental hazards
a. Broken stairs
b. Pointed or sharp objects, poisons, and medicines improperly kept
 c. Fire hazards
d. Fall hazards
5. Nutritional
a. Inadequate food intake both in quantity and quality
b. Excessive intake of certain nutrients
c. Faulty eating habits
6. Stress-provoking factors
a. Strained marital relationships
b. Strained parent-sibling relationship
c. Interpersonal conflicts between family members
7. Poor environmental sanitation
a. Inadequate living space
b. Inadequate personal belonging/utensils
c. Lack of food storage facilities
d. Polluted water supply
e. Presence of breeding places of insects and rodents
f. Improper garbage/refuse disposal
g. Unsanitary waste disposal
h. Improper drainage system
i. Poor lighting and ventilation
j. Noise pollution
k. Air pollution
8. Unsanitary food handling and preparation
9. Personal habits/practices
a. Frequent drinking alcohol
b. Excessive smoking
c. Walking barefooted
d. Eating raw meat/fish
e. Poor personal hygiene
f. Self-medication
g. Use of dangerous drugs/narcotics
h. Sexual promiscuity
i. Engaging in dangerous sports
10. Inherent personal characteristics- e.g. short temper
11. Health history which may precipitate/induce the occurrence of a health deficit-
e.g. previous history of difficult labor
12. Inappropriate role assumption
13. Lack of immunization/inadequate immunization status specially of children
14. Family disunity
15. Others, specify

B. HEALTH DEFICIT
-instances of failure in health maintenance
1. Illness states regardless whether it is diagnosed or underdiagnosed by medical
practitioner.
 2. Failure to thrive/develop according to normal rate
3. Disability arising from illness, whether transient/temporary
-e.g. paralysis, leg amputation, blindness, and lameness
C. FORSEEABLE CRISIS OR STRESS POINTS
- Anticipated periods of unusual demand on the individual or family in terms of
adjustment/family resources
1. Marriage
2. Pregnancy, labor
3. Parenthood
4. Additional member- e.g. new born, lodger
5. Abortion
6. Entrance at school
7. Adolescence
8. Loss of job
9. Death of a member
10. Resettlement in a new community
11. Illegitimacy
12. Others, specify

IV. DETERMINE THE NATURE AND EXTENT OF THE FAMILY’S

PERFORMANCE OF THE HEALTH TASKS ON EACH OF THE HEALTH
PROBLEMS CATEGORIZED IN NO.3

TOOL: TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING

PRACTICE: SECOND LEVEL ASSESSMENT

I. INABILITY TO RECOOGNIZE THE PRESENCE OF A PROBLEM DUE

TO:
A. Ignorance of facts
B. Fear of consequences of diagnosis of problem
1. Social stigma loss of respect of peer/significant others
2. Economic cost
3. Physical/psychological
C. Attitude/Philosophy
D. Others, specify

II. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING

APPROPRIATE HEALTH ACTION DUE TO:
A. Failure to comprehend the nature, magnitude/scope of the problem
B. Low salience of the problem
C. Feeling of confusion and/or resignation brought about by failure to break
down problems into manageable units of attack
D. Lack of 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 or significant others regarding
action to take
G. Ignorance of community resource for care
H. Fear of consequences of action
I. Negative attitude towards the health problem- by negative attitude is meant
one that interfere as with rational decision-making
J. Inaccessibility of appropriate resources of care
K. Lack of trust/confidence in the health personnel or agency
L. Misconceptions or erroneous information about proposed courses of action
M. Others, specify

III. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE SICK,

DISABLED, DEPENDENT OR VULNERABLE OR AT RISK MEMENER
OF THE FAMILY DUE TO:
A. Ignorance of facts about the disease or health condition (nature, severity,
complications, prognosis, and management); child development and child
care
B. Ignorance of the nature and extent of nursing care needed
C. Lack of the necessary facilities ( equipment and supplies ) for care
D. Lack knowledge and skill in carrying out the necessary
treatment/procedure/care
E. Inadequate family resources of care
F. Negative attitude towards the sick, disabled, dependent, vulnerable
G. Attitude/philosophy in life
H. Member’s preoccupation with own concerns/interests
I. Others, specify

IV. INABILITY TO PROVIDE A HOME ENVIRONMENT WHICH IS

CONDUCIVE TO HEALTH MAINTENANCE AND PERSONAL
DEVELOPMENT DUE TO:
A. Inadequate family resources
B. Failure to see benefits (specially long-term ones) of investment in home
environment improvement
C. Ignorance of importance of hygiene and sanitation
D. Ignorance of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication patterns
G. Attitude/philosophy in life
H. Others, specify

V. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR HEALTH

CARE DUE TO:
A. Ignorance or lack of awareness of community resources for health care
B. Failure to perceive the benefits of health care or services
 C. Lack of trust or confidence in the agency or personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action
F. Unavailability of required care/service
G. Inaccessibility of required care/service
H. Lack or inadequate family resources
I. Feeling of alienation of lack of support from the community
J. Attitude/philosophy in life
K. Others, specify

V. DETERMINE PRIORITIES AMONG THE LIST OF HEALTH PROBLEMS

TOOL: SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO
PRIORITIES

A. NATURE OF THE PROBLEM

- categorizes the problem as health threat, health deficit, or stress points
B. MODIFIABILITY OF THE PROBLEM
- Refers to the probability of success in minimizing, alleviating or totally eradicating the
problem through nursing intervention

1. Current knowledge, technology, and interventions to manage the problem

2. Resources of the family- physical, financial and manpower
3. Resources of the nurse- knowledge, skills and time
4. Resources of the community- facilities and community organization or support

C. PREVENTIVE POTENTIAL OF THE PROBLEM

- Refers to the nature and magnitude of future problems that can be minimized or totally
prevented if intervention is done on the problem under consideration

1. Gravity or severity of the problem

2. Duration of the problem
3. Current management
4. Exposure of any high risk group

D. SALIENCE OR FAMILY’S PERCEPTION/ EVALUATION OF EACH PROBLE IN

TERMS OF SERIOUSNESS AND URGENCY BASED ON PRIORITIES SET

VI. RANK THE HEALTH PROBLEMS ACCORDING TO PRIORITIES

VII. DECIDE ON WHAT PROBLEMS TO TACKLE IN THE ORDER OF
IMMEDIACY/URGENCT, BASED ON PRIORITIES SET
VIII. DEFINES NURSING OBJECTIVES (SMART) JOINTLY WITH THE FAMILY
IX. PLANS APPROACHES, STRATEGIES OF ACTION CRITERIA AND STANDARDS
FOR EVALUATION
X. IMPLEMENTS THE PLAN OF CARE
XI. EVALUATES THE EFFECTIVITY OF IMPLEMENTED ASPECTS OF THE PLAN
XII. REDEFINES NURSING PROBLEMS AND REFORMULATES OBJECTVES
ACCORDING TO EVALUATION FINDINGS
FORMAT OF THE FAMIL NURSING CAREP PLAN
1. Health problem
2. Family nursing problems
3. Goals of care
4. Objectives of care
5. Intervention measures
6. Method of Nurse-Family Contact
7. Resources Required
8. Evaluation
COMPONENTS
1. HEALTH PROBLEM
- A situation or condition which interferes with the promotion and/or maintenance of health
and recovery from illnesses and injury

2. FAMILY NURSING PROBLEMS

- A health problem becomes a nursing problem when it can be modified through nursing
interventions

3. GOALS OF CARE
- General statements of purpose
- The end towards which all efforts are directed
- Broadly state
- Not measurable

4. OBJECTIVES OF CARE
- are more specific statements of the desired results of outcome after giving the nursing
intervention
5. INTERVENTION MEASURES
- Refers to the expected behaviours that the nurse will perform with the patient must be
taken for a source and must have a footnote at the end of each intervention.