UNIVERSITY OF THE CORDILLERAS

College of Nursing

NCM 104: COMMUNITY HEALTH NURSING (Skills)

I. NURSING ASSESSMENT IN FAMILY NURSING PRACTICE

 Nursing assessment is the first major phase of the nursing process. In family health nursing
practice, this involves a set of actions by which the nurse measures the status of the family as a
client, its ability to maintain itself as a system and functioning unit, and its ability to maintain
wellness, prevent, control or resolve problems in order to achieve health and well-being
among its members.

TWO MAJOR TYPES:

1. First-level assessment – is a process whereby existing and potential health conditions or
problems of the family are determined.
2. Second-level assessment – defines the nature or type of nursing problems that the family
encounters in performing tasks with respect to a given health condition or problem, and the
etiology or barriers to the family’s assumption on these tasks.

STEPS IN FAMILY NURSING ASSESSMENT

1. DATA COLLECTION METHODS AND TOOLS:
a. Observation – done through the use of the sensory capacities – sight, hearing, smell or
touch. The family’s health status can be inferred from signs and symptoms of problem.
b. Physical Examination – done through inspection, palpation, percussion, auscultation,
measurement of specific body parts and reviewing the body system.
c. Interview – one type of interview is completing a health history for each family member.
The history determines current health status based on significant past health history
- Second type is collecting data by personally asking significant family
members or relatives questions regarding health, family, life experiences and
home environment to generate data on what wellness condition and health
problems exist in the family.
d. Record Review - through reviewing existing records and reports pertinent to the client.
These include the individual clinical records of the family members, laboratory and
diagnostic reports, immunization records, reports about the home and environment
e. Laboratory/Diagnostic Tests – through performing laboratory tests, diagnostic procedures,
or other tests of integrity and functions carried out by the nurse and/or other health
workers.

2. DATA ANALYSIS
a. Sorting of data for broad categories such those related with the health status or practices
of family members or data about home and environment;
b. Clustering of related cues to determine relationships between and among data;
c. Distinguish relevant from irrelevant data;
d. Identifying patterns such as physiologic function, developmental, nutritional/dietary,
coping adaptation or communication patterns and lifestyle;
e. Comparing patterns with norms or standards of health, family functioning and assumption
of health tasks;
f. Interpreting results of comparisons to determine signs and symptoms or cues of specific
wellness state/s, health deficit/s, health threat/s or foreseeable crisis/stress point/s and their
underlying causes or associated factors; and
g. Making interferences or drawing conclusions about the reasons for the existence of the
health condition, problem, risk factor/s related to non- maintenance of wellness state/s
which can be attributed to non-performance of family health tasks.

3. NURSING DIAGNOSES
This includes 2 types:
a. The definition of wellness state/potential or health condition or problem as an end product
of first-level assessment.

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 b. The definition of family nursing problems as an end result of second-assessment

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

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 inthe family
3. Place of residence of each member – whether living with the family or elsewhere
4. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended
5. Dominant family members in terms of decision-making, especially in matters of health care
6. General family relationship/dynamics – presence of any obvious/readily observable
conflict between members; characteristic communication/interaction patterns among
members

B. Socio-economic and Cultural Characteristics

1. Income and Expenses
a. Occupation, place of work and income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about money and how it i 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

C. Home and Environment

1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Presence of breeding or resting sites of vectors of diseases
d. Presence of accident hazards
e. Food storage and cooking facilities
f. Water supply – source, ownership, potability
g. Toilet facility – type, ownership, sanitary condition
h. Garbage/refuse disposal – type, sanitary condition
2. Kind of neighborhood,’
3. Social and health facilities available
4. Communication and transportation facilities available

D. Health Status of each Family Member

1. Medical and nursing history indicating current or past significant illnesses or beliefs and
practices conducive to health and illness
2. Nutritional assessment (specially for vulnerable or at-risk members)
a. 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 ratio (WHR = waist
circumference in cm. divided by hip circumference in cm. Central Obesity: WHR equal
to or greater than 1.0 cm in men and 0.85 in women)
b. Dietary history specifying quality and quantity of food/nutrient intake per day
c. Eating/feeding habits/practices
3. Developmental assessment of infants, toddlers, and preschoolers
4. Risk factor assessment indicating presence of major and contributing modifiable risk factors
for specific lifestyle diseases
5. Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by
medical practitioners)
6. Results of laboratory/diagnostic and other screening procedures supportive of assessment
findings

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 E. Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention,
Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices
3. Adequacy of:
a. Rest and sleep
b. Exercise/activities
c. Use of protective measures
d. Relaxation and other stress management activities
4. Use of promotive-preventive health services

TYPOLOGY OF NURSING PROBLEMS IN FAMILY PRACTICE

FIRST-LEVEL ASSESSMENT

I. Presence of Wellness Condition – stated as Potential or Readiness- a clinical or nursing

judgement about a client in transition from a specific level of wellness or capability to a
higher level. Wellness potential is a a nursing judgement on wellness state or condition
based on client’s performance, current competencies or clinical data but NO explicit
expression of client desire. Readiness for enhanced wellness state is a nursing judgement
on wellness state or condition based on client’s current competencies or 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.

Examples:
A. Potential for Enhanced Capability for:
1. Healthy Lifestyle
2. Health Maintenance/Health Management
3. Parenting
4. Breastfeeding
5. Spiritual Well-being
6. Others
B. Readiness for Enhanced Capability for:

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:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases, metabolic syndrome)
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards
1. Broken stairs
2. Pointed/sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others )specify)
E. Faulty/unhealthful nutritional/eating habits or feeding techniques 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 techniques

F. Stress-provoking factors – specify

1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members

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 4. Care-giving burden
G. Poor home/environment 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
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lighting and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary food handling and preparation
I. Unhealthful lifestyle and personal habits/practices –specify:
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate foot wear
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 exercise/physical activity
10. Lack o/inadequate relaxation activities
11. Inadequate rest or sleep
12. Non-use of self-protection measures
J. Inherent personal characteristics
K. Health history which may participate/induce the occurrence of a health deficit
L. Inappropriate role assumption
M. Lack of immunization/inadequate immunization status specially of children\
N. Family disunity
1. Self-oriented behaviour or member(s)
2. Unresolved conflicts of members
3. Intolerable disagreement

III. Presence of Health Deficits – instances of failure in health maintenance.

A. Illness states, regardless of whether it is diagnosed or undiagnosed by medical
practitioner
B. Failure to thrive/develop according to normal rate
C. Disability – whether congenital or arising from illness,; transient/ temporary (temporary
paralysis after a CVA) or permanent

IV. Presence of Stress Points/Foreseeable Crisis Situations – anticipated periods of unusual

demand on the individual or family in terms of adjustment/family resources.
A. Marriage I. Menopause
B. Pregnancy, labor, puerperium J. Loss of job
C. Parenthood K. Hospitalization of a family member
D. Additional member L. Death of a member
E. Abortion M. Resettlement in a new community
F. Entrance at school N. Illegitimacy
G. Adolescence
H. Divorce or separation

SECOND-LEVEL ASSESSMENT

I. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequence of diagnosis
of problems, specifically:

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 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

II. Inability to make decisions with respect to taking appropriate health action due to:
A. Failure to comprehend the nature/magnitude of the problems/condition
B. Low salience of the problem/condition
C. Felling of confusion, helplessness and/or resignation brought about by perceived
magnitude/severity of the situation or problem
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 consequence
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem
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

III. Inability to provide adequate nursing care to the sick, disabled, dependent or
vulnerable/at-risk member of the family due 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. healthy lifestyle program)
F. Inadequate family resources for care, specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitations/lack of physical resources
G. Significant person’s unexpressed feelings which disable his/her capacities to provide
care.
H. Philosophy in life which negates/hinder 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 confusion
6. Role overload

IV. Inability to provide a home environment conducive to health maintenance and

personal development due to:

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 A. Inadequate family resources, specifically:
1. Financial constraint/limited financial resources
2. Limited physical resources
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)

V. Failure to utilize community resources for health care due 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
F. Unavailability of required care/service
G. Inaccessibility of required care/service due to:
1. Cost constraint
2. Physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically:
1. Manpower resources
2. Financial resources
I. Feeling of alienation to/lack of support from the community
J. Negative attitude/philosophy in life which hinders effective/maximum utilization
of community resources for health care

DEVELOPING THE NURSING CARE PLAN

FAMILY NURSING CARE PLAN

- Is the blueprint of the care that the nurse designs to systematically minimize
the identified health and family nursing problems through explicitly formulated
outcomes of care ( goals and objectives) and deliberately chosen set of
interventions, resources and evaluation criteria, standards, methods and tools

Desirable Qualities of a Nursing Care Plan

1. It should be based on clear, explicit definition of the problem/s.
2. A good plan is realistic
3. The NCP is prepared jointly with the family
4. The NCP is most useful in written form.

IMPORTANCE OF PLANNING CARE

1. Individualize care
2. Helps set priorities
3. Promote systematic communication
4. Promotes continuity of care

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 5. Facilitates coordination of care

PRIORITIZING HEALTH PROBLEMS

1. Nature of the condition or problem presented – categorized into wellness state/potential,
health threat, health deficit and foreseeable crisis;
2. Modifiability of the condition or problem – refers to the probability of success in enhancing the
wellness state, improving the condition, minimizing, alleviating or totally eradicating the
problem through intervention;
3. Preventive Potential – refers to the nature and magnitude of future problems that can be
minimized or totally prevented if intervention is done on the condition or problem under
consideration;
4. Salience - refers to the family’s perception and evaluation of the condition or problem in
terms of seriousness and urgency of attention needed or family readiness

Prepared by:
OWEN MARI L. DOMONDON

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