FAMILY NURSING PROCESS By: Mareneth A.

Rivera-Borromeo, RN,MAN
 NURSING PROCESS
▪ main framework or guide in nursing practice and the means
by which nurses work with client-partners to enhance wellness
or address the health needs and problems of their clients.

▪A logical and systematic way of processing information

gathered from different sources and translating intentions into
meaningful actions or interventions.
 FIVE PHASES OF NURSING PROCESS

1. Assessment

2. Diagnosis

3. Planning

4. Implementation

5. Evaluation
ASSESSMENT

➢deals with collecting, organizing, validating and

recording data about a client’s health status.

 ACTIVITIES IN ASSESSMENT
a. Identifying assessment priorities determined by the purpose of the assessment and
the client’s condition
b. Prioritizing types of data to be collected systematically
c. Establishing the data base
- nursing history
- physical examination
- review of client record and nursing literature
- consultation with health professionals and client’s support persons
 ACTIVITIES IN ASSESSMENT

d. Continuous updating of the records

e. Validating data

f. Communicating data
 TYPES OF
ASSESSMENT
 TYPES OF ASSESSMENT
1. FIRST LEVEL ASSESSMENT
- process of determining existing and potential health conditions and problems of the
family.
Health condition category:
a. Wellness condition (potential or readiness)- clinical or nursing judgement about a
client in transition from a specific level of wellness or capability
b. Health threats-conditions that are conducive to disease, accident, or failure to
realize one’s health potential
c. Health deficits- instances of failure in health maintenance
d. Stress points/foreseeable crisis- anticipated periods of unusual demand on the
individual or family in terms of adjustment or family resources
DATA COLLECTION
- involves gathering five types of data namely:

1. Family structure and characteristics

2. Socio-economic and cultural factors
3. Environmental factors
4. Health assessment of each member
5. Value placed on health promotion, health maintenance and prevention of
disease
Data gathering methods include:

❖Observation
❖Physical examination
❖Interview
❖Review of records
❖Laboratory and diagnostic
procedures
TYPES OF ASSESSMENT
2. SECOND LEVEL ASSESSMENT

➢Identifies the nature or type of nursing problems the family experiences in the

performance of their health tasks with respect to a certain health condition or health

problem
HEALTH TASKS ( RUTH FREEMAN)
▪ ability to recognize the existence of a wellness state, health condition, or a health
problem
▪Ability to make decisions with respect to taking appropriate health actions
▪Ability to provide nursing care to the affected (sick, disabled, dependent, or at risk)
family member
▪Ability to provide a home environment conducive to health maintenance and personal
development.
▪Ability to provide a home environment conducive to health maintenance and personal
development
▪Ability to utilize community resources for health care
FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS
(TYPOLOGY OF NURSING PROBLEMS)
❑Inability to recognize the existence of a health condition/ problem

❑Inability to make decisions with respect to taking appropriate health action

❑Inability to provide nursing care to the sick, disabled or dependent member

of the family

❑Inability to provide a home environment that is conducive to health

maintenance and personal development

❑Failure to utilize community resources for health care.

 INITIAL DATA BASE
A. Family Structure Characteristics and Dynamics
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 the family or
elsewhere
4.Type of family structure-e.g. patriarchal, matriarchal, nuclear or extended
5.Dominant family members in terms of decision making especially on
matters of health care
6.General family relationship/dynamics-presence of any obvious/readily
observable conflict between members; characteristics,
communication/interaction patterns among members.
 INITIAL DATA BASE
B. Socio-economic and Cultural Characteristic
1.Income and expenses
1. Occupation, place of work and income of each working member
2. Adequacy to meet basic necessities (food, clothing, shelter)
3. Who makes decision about money and how it is spent

2.Educational Attainment of each Member

3.Ethnic Background and Religious Affiliation
4.Significant others-role (s) they play in family’s life
5. Relationship of the family to larger community-nature and extent of
participation of the family in community activities
 INITIAL DATA BASE
C. Home Environment
1.Housing
1. Adequacy of living space
2. Sleeping in arrangement
3. Presence of breathing or resting sites of vector of diseases (e.g. mosquitoes, roaches, flies,
rodents, etc.)
4. Presence of accident hazard
5. Food storage and cooking facilities
6. Water supply-source, ownership, pot ability
7. Toilet facilities-type, ownership, sanitary condition
8. Garbage/refuse disposal-type, sanitary condition
9. Drainage System-type, sanitary condition
2.Kind of Neighborhood, e.g. congested, slum etc.
3.Social and Health facilities available
4.Communication and transportation facilities available
 INITIAL DATA BASE
D. Health Status of Each Family Member
1.Medical Nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness
2.Nutritional assessment (especially for vulnerable or at risk members)
1. Anthropometric data: measures of nutritional status of children-weight, height, mid-
upper arm circumference; risk assessment measures for obesity : body mass
index(BMI=weight in kgs. divided by height in meters2), waist circumference (WC:
greater than 90 cm. in men and greater than 80 cm. in women), waist hip
ration (WHR=waist circumference in cm. divided by hip circumference in cm.
Central obesity: WHR is equal to or greater than 1.0 cm in men and 0.85 in women)
2. dietary history specifying quality and quantity of food or nutrient per day
3. Eating/ feeding habits/ practices
 INITIAL DATA BASE
1.Developmental assessment of infant, toddlers and preschoolers- e.g. Metro
Manila Developmental Screening Test (MMDST).
2.Risk factor assessment indicating presence of major and contributing
modifiable risk factors for specific lifestyle diseases-e.g. hypertension,
physical inactivity, sedentary lifestyle, cigarette/ tobacco
smoking, elevated blood lipids/ cholesterol, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol drinking, and other
substance abuse.
3.Physical Assessment indicating presence of illness state/s (diagnosed or
undiagnosed by medical practitioners )
4.Results of laboratory/diagnostic and other screening procedures supportive
of assessment findings.
 INITIAL DATA BASE
E. Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention. Examples include:
1.Immunization status of family members
2.Healthy lifestyle practices. Specify.
3.Adequacy of:
1. Rest and sleep
2. Exercise/activities
3. Use of protective measure-e.g. adequate footwear in parasite-infested areas; use of
bed nets and protective clothing in malaria and filariasis endemic areas.
4. Relaxation and other stress management activities

4.Use of promotive-preventive health services

FAMILY COPING INDEX

➢ tool used to assess the coping ability of the family for certain health situation

with its purpose of providing a basis for estimating the nursing needs of a

particular family.
A nursing need is need is present when:
✓The family has a health problem with which they are
unable to cope.
✓There is reasonable likelihood that nursing will make a
difference in the family’s ability to cope.
FEATURES
➢Nursing needs can be defined in terms that is in relation to the nursing
intervention that is required.
➢Nursing needs must be based on nursing itself.
➢The health problem, the attitude and knowledge of the family, the
availability to medical and hospital resources will determine in some measure
the mix of nursing skills required by a particular time but regardless of the
type of problem, the area and the extent of nursing practice required can be
analyzed using a single rubric.
Coping
defined as dealing with problems associated with care with
reasonable success
Coping deficit
when the family is unable to cope with one and other aspect of
health care
To Cope
ability or capacity to deal with health situation; the control with
the health competence of the family
DIRECTION FOR SCALING
A Point of the Scale
Enables you to place the family in relation to their ability to cope
with nine areas of the family nursing at the time observed and as
you would expect it to be in 3 months or at time of discharged if
nursing care were provided.
Coping capacity is rated from
 1--totally unable to manage this aspect of family care
 5--able to handle the aspect of care and help from community
sources
Scaling Cues: (limited to 3 points)
Scale 1—poor competence or low competence
3—moderate competence
5—high competence (complete)

When each of 9 categories has been rated, the result will be a

profile of family coping capacity in relation to the family nursing
required and by the changes you expect to occur in the course of
nursing service.
Justification Statement
Consist of brief statements or phrases that explain why
you have rated the family as you have
expressed in terms of behavior or observable facts
rather than in adjectives
GENERAL CONSIDERATIONS:
✓It is the coping capacity and not the underlying problem
that is being rated.
Example: A person with serious cardiac condition.
✓It is the family and not the individual that is being rated.
In rating, it is your own professional judgment that will be
needed to make a decision.
NINE AREAS OF FAMILY NURSING FAMILY COPING
INDEX:
1) Physical Competence
2) Therapeutic Competence
3) Knowledge of Health Condition
4) Application of Principle of General Hygiene
5) Health Attitudes
6) Emotional Competence
7) Family Living
8) Physical Environment
9) Use of Community Facilities
DATA ANALYSIS
➢ After collection of data, the nurse goes through data analysis wherein she sorts out
and classifies or groups data by type or nature (wellness, threats, deficits or stress
points/foreseeable crises).

➢Then, she relates them with each other determines patterns or reoccurring themes
among data.

➢She then, compares this to norms or standards.

TYPES OF STANDARDS OR NORMS USED IN
DETERMINING THE STATUS OF A FAMILY
❖Normal health of individual members

❖Home and environmental conditions conducive to health development

❖Family characteristics, dynamics or level of functioning conducive to family growth

and development.
TYPES OF STANDARDS OR NORMS USED IN
DETERMINING THE STATUS OF A FAMILY
1. Normal health of members
- involves physical, social and emotional well-being of each family member
2. Home and environmental conditions
- include both the physical, as well as psychological and socio-cultural milieu.
3. Family characteristics
- constitutes the client’s ability as a system to maintain its boundary integrity
and achieve its purposes through a dynamic interchange among its members while
responding to external until environment continuum.
QUALIFICATIONS TO ACHIEVE WELLNESS
1. Recognize the presence of a wellness state or health condition or problem
2. Make decision about taking appropriate health action to maintain wellness or
manage the health problem
3. Provide nursing care to the sick, disabled, dependent or at risk members
4. Maintain a home environment conducive to health maintenance and personal
development
5. Utilize community resources for health care.
- After relating family data to relevant clinical or research findings and comparison
of patterns with norms or standards, assessment data, as categorized or reorganized,
are interpreted and inference is drawn.

- end result of analysis during the first level assessment is a conclusion or statement
of a health condition or problem, classified as a wellness potential, health threat,
health deficit or foreseeable crisis.
CONSTITUTES THE FOLLOWING:

1. Transition state from a specific level of wellness to a higher level;

2. Medical or nursing diagnosis indicating current health status of each family

member;

3. Condition of home and environment conducive to disease/ illness or accidents

4. Maturation/ development or situational crisis situation.

➢ second level of analysis ends with a definition of family nursing problem
➢To define family nursing problems, each wellness state or health condition or
problem must be analyzed in terms of how the family handles it.
 DIAGNOSIS

➢ identification of the client’s wellness status or needs and

problems based on an analysis of the data/ information

gathered.
 ACTIVITIES IN DIAGNOSIS

a. Interpreting and analyzing client data

b. Identifying client strengths and health problems

c. Formulating and validating nursing diagnoses

 PLANNING

➢ a deliberative, systematic phase of the nursing process that involves decision

making and problem solving.

➢It involves a series of steps in which the nurse and the client set priorities and

goals or expected outcomes to resolve or minimize the identified client

problems
 ACTIVITIES IN PLANNING

a. Establishing priorities

b. Writing goals/ outcomes and developing an evaluative strategy

c. Selecting nursing intervention

d. Communicating the plan of nursing care

 IMPLEMENTATION

➢a phase in which the nurse puts the

nursing care plan into action
 ACTIVITIES IN IMPLEMENTATION

a. Carrying out the plan of care

b. Continuous data collection and modification of the plan of care as needed.

c. Documentation of care
 EVALUATION

➢ a planned, ongoing, purposeful activity in which clients and health care

professionals determine the client’s progress toward goal achievement, and the

effectiveness of the care plan.

 ACTIVITIES IN EVALUATION
a. Measuring how well the client has achieved desired goals or outcomes
b. Identifying factors contributing to the client’s success or failure
c. Modifying the plan of care, if necessary.