FAMILY NURSING

PROCESS
A. FAMILY HEALTH ASSESSMENT
B. FAMILY NURSING DIAGNOSIS

By: Katreena Ness J. Olila, RN

INTRODUCTION
■ Family nursing is the practice of nursing directed towards maximizing the
health and well-being of all individuals within a family system (Maurer &
Smith)
■ Family nursing care maybe focused on the individual family member,
within the context of the family or the family unit.
■ The nurse establishes a relationship with each family member within the
unit and understands the influence of the unit on the individual and society.
■ The school nurse has a unique opportunity to compare the child in the
school system with the child in the family system.
■ The occupational health nurse can use a family approach to improve the
health of the worker and contribute to overall productivity.
■ Remember: even if the nurse desires to help the family in health and
related matters, a primary consideration is the family’s willingness to
utilize nursing services.
FAMILY HEALTH ASSESSMENT
■ Nursing assessment is the first major phase of the nursing process.
■ Family assessment helps the nurse identify the health status of individual
members of the family and aspects of family composition, function and
process.
■ The process of the family assessment is unceasing and requires objectively
and professional judgment to attach practical meaning to the information
being acquired.
■ Tools are develop to allow more systematic and organized classification
and analysis of data.
■ Data about the present condition or status of the family are compared
against norms or standards of personal (such as values, beliefs, principles,
rules or expectation), social and environmental health, system integrity and
ability to resolve system problems.
FAMILY HEALTH ASSESSMENT
Family Health Assessment Guidelines
■ Family Health Assessment Guidelines – often includes information
about the environment, community context and information about the
family. It should serve as a guide only, as a means to record
pertinent information about the family that will assist the nurse in
working with the family.
■ Obtain through interviews with one or more family members or
group interviews
■ Also obtain through observation of individual family members and
observation of the environment the family lives, including housing,
their neighborhood and community.
■ Secondary data can be taken from a review of records like charts,
health center records and agency records
FAMILY HEALTH ASSESSMENT
Genogram
■ It is a tool that helps the nurse outline the family structure.
■ It is a way to diagram a family.
■ May used be used by the nurse during the early family interview.
■ The usefulness of the genogram is limited by how freely the family
member relates significant information such as separations and
remarriages or family health concerns.
■ Some families may be sensitive to the sharing of such information,
particularly when it is shown to recur with each generation.
■ For other families, the development of the genogram is an excellent
opening to the discussion of family history or hereditary health
problems.
 Sample genogram of Jhondy’s family

Vicente Ernesto
Died 55 Fina Died 33 Nelsa
years old 60 years years old 56 years
Lung Cancer Cardiac Arrest

Mercy Jhondy Ness

26 years 30 years 30 years

Jasmin Jareed
5 years 15 months
FAMILY HEALTH ASSESSMENT
Family Health Tree
 based on the genogram that provides a mechanism of
recording the family’s medical and health history.
 It can be used on planning positive familial influences on risk
factors such as diet, exercise, coping with stress or pressure.
 The nurse should note the following: cause of death of family
members, genetic linked diseased (cancer, diabetes,
hypertension, allergies, asthma, mental retardation),
environmental and occupational disease, psychosocial problems
(mental illness and obesity), infectious diseases, family risk
factors from health problems, lifestyle-related risk factors
FAMILY HEALTH ASSESSMENT
Ecomap
 “Ecomap portrays an overview of the family in their situation; it depicts
the important nurturant or conflict-laden connections between the family
and the world. It demonstrate the flow of resources, or the lacks and
deprivations. this mapping procedure highlights the nature of the
interfaces and points to conflicts to be mediated, bridges to be built, and
resources to be sought and mobilized.” (Hartman, 1979)
 The ecomap shows contacts that occur between the family and the
suprasystem.
 This tool helps increase the nurse’s awareness of the family within the
community and help guide the nurse and the family in the assessment and
planning phases of care.
 Elderly Elderly
Rider mother mother
Organiza
& &
tion
siblings siblings

Small Work
Business Jhondy Ness
& Farm 30 years 30 years

Jasmin Jareed Neighbo

5 years 15 months rs
School

Barangay
Church Health
Center
Jhondy’s Family Ecomap
FAMILY HEALTH ASSESSMENT
Nursing assessment includes:
 Data Collection
 Data Analysis/Interpretation
 Problem Definition or Nursing Diagnosis

2 Major Types of Nursing Assessment in Family Nursing

Practice:
 First-Level Assessment
 Second-Level Assessment
FAMILY HEALTH ASSESSMENT
Data Collection
First level assessment involves gathering of 5 types of data which
will generate the categories of health condition or problems of the
family.
1. Family structure, characteristics, and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health Status of each member
5. Values and practices on health promotion and maintenance
and illness prevention
 FAMILY HEALTH ASSESSMENT
Data Collection
1. Family Structure, Characteristics, and
Dynamics
 Members of the household and relationship to
the head of the family
 Demographic data
 Place of residence of each member
 Type of family structure – matriarchal or
patriarchal, nuclear or extended
 Dominant family members in terms of decision
making
 General family relationships or dynamics
2. Socio-Economic and Cultural Characteristics
 Income and expenses
• Occupation and place of work of each
member
• Adequacy to meet basic needs
• Who makes decision about family
expenditure
 Educational attainment of each member
 Ethnic background and religious affiliation
 Significant others and role(s) they play in the
family
 Relationship of the family to a larger community
 FAMILY HEALTH ASSESSMENT
Data Collection
3. Home and Environment 3. Home and Environment
 Housing  Kind of neighborhood
• Adequacy of living space  Social and health facilities available
• Sleeping arrangement  Communication and transportation facilities
• Presence of breeding or resting sites of available
vectors of diseases
• Presence of accident hazards
• Food storage and cooking facilities
• Water supply
• Toilet facility
• Garbage disposal
• Drainage system
FAMILY HEALTH ASSESSMENT
Data Collection
4. Health Status of each Family Member
 Medical history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness
 Nutritional assessment (anthropometric data, dietary history, eating/feeding
habits/practices)
 Risk factor assessment indicating presence of major and contributing
modifiable risk factors for specific lifestyle diseases
 Physical assessment indicating presence of illness state/s
 Results of laboratory/diagnostic and other screening procedures
supportive of assessment findings
FAMILY HEALTH ASSESSMENT
Data Collection
5. Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention
 Immunization status
 Healthy lifestyle practices
 Adequacy of:
◦ Rest and sleep
◦ Exercise/activities
◦ Use of protective measures
 Use of promotive and preventive health services
FAMILY HEALTH ASSESSMENT
Data Collection
Data Gathering Methods and Tools
1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory and Diagnostic Tests
FAMILY HEALTH ASSESSMENT
Data Analysis
 Data analysis is done by comparing findings with accepted standards for
individual family members and for the family unit.
 The nurse correlates findings in the different data categories and checks
for significant gaps in the information or the need for more details related
to a finding.
 The following is a system of organizing family data (Nies & McEwen,
2011):
1. Family structure and characteristics
2. Socio-economic characteristics
3. Family environment
4. Family heath and health behavior
FAMILY HEALTH ASSESSMENT
Data Analysis
Involves several sub-steps:
1. Sorting of data
2. Clustering of related cues
3. Distinguishing relevant from irrelevant data
4. Identifying patterns – such as psychosocial function, developmental,
dietary, coping or communication pattern and lifestyles
5. Comparing patterns with norms or standards of health, family functioning
and assumption of health tasks
6. Interpreting results of comparisons to determine signs symptoms or cues
of specific wellness state, health deficit, health threat or foreseeable crisis
7. Making interference or drawing conclusions about the reasons for the
existence of the problems, health conditions and risks factors
FAMILY HEALTH ASSESSMENT
Diagnosis
Wellness condition – a nursing judgment related with the client’s capability
of wellness.
Health condition-problem – a situation that interferes with the promotion or
maintenance of health from illness or injury.
Nursing Diagnosis – a wellness state or health problem became a nursing
problem when the family has failure to perform adequately specific health
tasks to enhance the wellness state or manage the health problem.

Two types:
1. The definition of wellness state or health condition or problems as an end
product of first-level assessment.
2. The definition of family nursing problem as an end result of second-level
assessment.
FAMILY HEALTH ASSESSMENT
Diagnosis
THE TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING
PRACTICE
 It is a tool used by nursing students, community health nurse
practitioners and educators.
 Adopted from Freeman’s health tasks.
 Contain 6 main categories of problems in 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 remaining five main categories of problems contains statement
of the family’s incapabilities in the assumption of the health tasks.
 Cues/Data Family Nursing Problem
FAMILY HEALTH ASSESSMENT
• Jareed at 15 months is FIRST LEVEL ASSESSMENT
Diagnosis eating rice lugaw and  Readiness for enhance
vegetables. capability for healthy
Situation: • Ms. Ness verbalized, “kusog lifestyle and breastfeeding
During a home visit, the community nurse kayo siya mu kaon og utan,
gather all the data she needed during wala gyod na siya naka
tilaw og cerelac.”
her interview to Ms. Ness. She noted that • Ms. Ness added, “ga
Ms. Ness missed her 3rd shot of TT breastfeed gihapon siya
hantod karon, wala koy
vaccine. While interviewing, the nurse
plano ipa undang og
observed that the 1st child, Jasmin had breastfeed ang bata kay
oral cavities. The second child, Jareed is kabalo ko maka ayo kini
hantod 2 years old.”
eating lugaw with vegetables. She also
observed that Mr. Jhondy is consuming a
cigarette while at home.
(Use the Typology of Nursing Problems in Family Nursing
Practice to determine the First & Second-Level
Assessment.)
 Cues/Data Family Nursing Problem
FAMILY HEALTH ASSESSMENT
• Jasmin, 5 years old have FIRST LEVEL ASSESSMENT
Diagnosis dental carries and  Dental Carries as Health
sometimes complained of Deficit
Situation: toothache.
During a home visit, the community nurse • Ms. Ness verbalized, “ga SECOND LEVEL ASSESSMENT
gather all the data she needed during gamit man gud siya og  Inability to provide
chopon sugod pag anak adequate nursing care to a
her interview to Ms. Ness. She noted that hantod nag 2 years kapin” child/member due to
Ms. Ness missed her 3rd shot of TT • Ms. Ness added, “kusog inadequate knowledge and
pajud kayo mu kaon og skills in carrying out the
vaccine. While interviewing, the nurse
chocolates and candies, nay necessary intervention and
observed that the 1st child, Jasmin had panahon maka tulog siya na care
oral cavities. The second child, Jareed is dili maka tooth brush”
eating lugaw with vegetables. She also
observed that Mr. Jhondy is consuming a
cigarette while at home.
(Use the Typology of Nursing Problems in Family Nursing
Practice to determine the First & Second-Level
Assessment.)
 Cues/Data Family Nursing Problem
FAMILY HEALTH ASSESSMENT
Diagnosis • Ms. Ness verbalized,  Presence of heath threat due
to inadequate immunization
“nalimtan gyod nako akong
3rd shot sa TT vaccine, maam. status
Situation:  Failure to utilize community
Na busy man gud ko sa
During a home visit, the community nurse trabaho og wala say maka
resources for health care due
to lack of family/manpower
gather all the data she needed during bantay sa mga bata para resources or baby sitter
her interview to Ms. Ness. She noted that maka lakaw ko.”  Inability to make decisions with
• The nurse review the respect to taking appropriate
Ms. Ness missed her 3rd shot of TT prenatal record of Ms. Ness health action due to low
vaccine. While interviewing, the nurse and verified the missed shot salience of the condition.
of TT vaccine.
observed that the 1st child, Jasmin had
oral cavities. The second child, Jareed is
eating lugaw with vegetables. She also
observed that Mr. Jhondy is consuming a
cigarette while at home.
(Use the Typology of Nursing Problems in Family Nursing
Practice to determine the First & Second-Level
Assessment.)
 Cues/Data Family Nursing Problem
FAMILY HEALTH ASSESSMENT
Diagnosis • During the home visit, the  Unhealthy lifestyle - Cigarette
smoking as Health Threat
nurse observed Mr. Jhondy,
consuming a stick of cigarette  Cigarette smoking – risk factor
Situation: of Lung Cancer as Health
• On her interview, she
During a home visit, the community nurse discovers that the father of
Threat
 Inability to recognize the
gather all the data she needed during Mr. Jhondy died due to Lung presence of a problem due to
her interview to Ms. Ness. She noted that Cancer attitude/philosophy in life in
• Ms. Ness verbalized that, “sa which hinders acceptance of a
Ms. Ness missed her 3rd shot of TT una paman na siya gapa- problem.
vaccine. While interviewing, the nurse nigarilyo, ako nang gina  Inability to provide adequate
badlong, kay maski naa na nursing care to
observed that the 1st child, Jasmin had sulod sa balay og adunay
dependent/vulnerable
members of the family due to
oral cavities. The second child, Jareed is mga bata, manigarilyo lack of knowledge about the
eating lugaw with vegetables. She also gihapon.” problem and about child
development
observed that Mr. Jhondy is consuming a  Inability to provide a home
cigarette while at home. environment conductive to
health maintenance and
(Use the Typology of Nursing Problems in Family Nursing personal development due to
Practice to determine the First & Second-Level negative attitude or
philosophy in life
Assessment.)
FAMILY HEALTH ASSESSMENT
Family Health Task
 The family serves as an essential resource for its members
by carrying out health tasks.
 An important responsibility of a community health nurse is
to develop the family’s capability in performing the health
tasks.
 The first family health task is providing its members with
means of health promotion and disease prevention such as
breastfeeding an infant, healthy diet for older family
members, immunization of infants and toddlers and
teaching young family members about proper hand
washing.
FAMILY HEALTH ASSESSMENT
Family Health Task
(according to Freeman and Heinrich, 1981)

 Recognizing interruptions of health or development.

 Seeking health care.
 Managing health and non-health crisis.
 Providing nursing care to sick, disable or dependent
members of the family.
 Maintaining a home environment conductive to good health
and personal development.
 Maintaining a reciprocal relationship with the community
and its health institutions.
FAMILY HEALTH ASSESSMENT
Family Coping Index
■ An alternative tool for nursing diagnosis based on the premise that nursing
action may help a family in providing for a health need or resolving a
health problem by promoting the family’s coping capacity.
■ It provides a system of identifying areas that may require nursing
intervention and areas of family strengths that may be used to help the
family deal with health needs and problems.
■ It focuses on identifying coping patterns of the family in 9 areas of
assessment.
■ The family will be rated numerically in a 5-point Likert scale, then
justifying the score given by the nurse by writing down observations that
support the rating given in the area.
 Area Definition Rating Justification
Physical Independence the ability to move about to get out of bed, to take care of daily grooming,
walking and other things which involves the daily activities.
Therapeutic the procedures or treatment prescribed for the care of ill, such as giving
Competence medication, dressings, exercise and relaxation, special diets.

Knowledge of Health the particular health condition that is the occasion of care
Condition
Application of Principles the family action in relation to maintaining family nutrition, securing adequate
of Personal and rest and relaxation for family members, carrying out accepted preventive
measures, such as immunization.
General Hygiene
Health Care Attitude the way the family feels about health care in general, including preventive
services, care of illness and public health measures.
Emotional Competence the maturity and integrity with which the members of the family are able to
meet the usual stresses and problems of life, and to plan for happy and
fruitful living.
Family Living Patterns the interpersonal with the interpersonal or group aspects of family life – how
well the members of the family get along with one another, the ways in which
they take decisions affecting the family as a whole.
Physical Environment the home, the community and the work environment as it affects family health.

Use of Community generally keeps appointments. Follows through referrals. Tells others about
Facilities Health Departments services
FAMILY HEALTH ASSESSMENT
Family Coping Index
 The Family Coping Index is measured with the following scores:
1 – No competence, 3 – moderately competence, 5 –complete competence

 General Consideration:
1. It is the coping capacity and not the underlying problem is being rated.
2. It is the family and not the individual is being rated.
3. Justification- a brief explanation why you have rated the family as you have.
4. The rating should be done after 2-3 home visits when the nurse is more
acquainted with the family.
5. Terminal rating is done at the end of the given period of time to enables the
nurse to see progress the family has made in their competence; whether the
prognosis was reasonable; and whether the family needs further nursing service
and where emphasis should be placed.
Example of Family
Coping Index
TO BE CONTINUED…