MIDTERM TOPIC: FAMILY NURSING ASSESSMENT STEPS IN NURSING ASSESSMENT

FAMILY NURSING PRACTICE Three steps in nursing assessment as applied to

family nursing process
 Family nursing practice emphasizes the need
to understand the behavior of the family as a 1. Data collection
dynamic, functioning unit which affects its
capability to help itself and maintain system 2. Data analysis
integrity, or its readiness to work with the
3. Formulation of diagnosis
nurse in enhancing wellness or addressing
problems on health and illness.
1. Data Collection- to ensure effective and efficient
 Theoretical frameworks provide directions by
data collection two important things in family nursing
which the nurse can organize observations,
practice. First, she has to identify the types of data
focus inquiries, design the application of the
needed and second, she needs to specify the methods
nursing process in family nursing practice.
of data gathering and the necessary tools to collect the
data.
FAMILY NURSING PRACTICE

First level assessment

1. The family systems theory views the family as
a living social system within a context in which
 is a process whereby data about the current
multiple environmental actions or factors occur
health status of individual members, for first
over the life course.
level assessment involves gathering of five
2. The interactional approach or symbolic
types of data which generates the categories
interactional framework views the family as a
of health conditions or problems of the family.
unity of interacting personalities whose actions
a) Family structure, characteristics and
are based on meanings they derived from
b) dynamics.
interactions and taken in an ever-changing
c) Socio-economic and cultural characteristics
process of new interactions, new
d) Home and environment
interpretation, and new meanings.
e) Health status of each member
3. The Developmental approach views family
f) Values and practices on health
development throughout its generational life
g) promotion/maintenance and disease prevention.
even highlighting critical periods of family
growth and development across the life course Second level assessment data
4. Structural-Functional perspective specifies
family characteristics such as member roles,  include those that specify or describe the

family forms, power structure, communication family's realities, perception and attitudes

processes and value systems which provide related to the assumption or performance of

order to family interactions and interdependent family health tasks on health condition or

relationships and serve to organize problem identified during the first level

performance of roles and functions. assessment.

5. Family Health Tasks Perspective it integrates

DATA GATHERING METHODS AND TOOLS
thee application of theoretical perspectives
which Convert particularly at the critical role of 1. Observation -through direct observation, the
family performance oi functions to attain, nurse gathers information about the family’s
sustain maintain and regain individual and state of being and behavioral responses.
family health. 2. Physical examination
 3. Interview
4. Record Review - the nurse may gather
information through reviewing existing records
and reports pertinent to the client.
5. Laboratory/Diagnostic Tests.
The Assessment Data Base (ADB)
 Is supported and complemented by other
family assessment tools to elicit generational
information about family structure and
processes (genogram factual data about family
relationship with the external environment and
its resources (ecomap) relationship and
interactive processes and family
problems/difficulties and strengths (family life
chronology)
Genograms
 Graphically display information about family
member and their relationships over at least
three generation.
 The Family Systems Theory of Murray Bowen
is used for construe as the conceptual
framework and analyzing genogram patterns
(structural, relational and functional information
about family) Viewed horizontally across the
family context and vertically through
generations.
Ecomap
 Visually diagrams the family’s interactions or
relationships with the external environment
and its resources. It summarizes on one page
the family strengths, conflicts and stresses in
relation to its interactions with individuals and
agencies outside the family system. Hartman
(1978) used the tool to examine boundary
maintenance aspects of family functioning.
The ecomap dramatically illustrates the
amount of energy used by a family to maintain
its system.
Family-life Chronology
 it helps capture family interactive processes
that have evolved (Satir 1967). It can help the
family identify the strengths in family member
relationships over time the need to alter family
functioning to reduce stress.
2. Data Analysis involves several sub steps
1. Sorting of data for broad categories
 2. Clustering of related cues to determine
relationship between and among data.
3. Distinguishing relevant from irrelevant data
4. Identifying patterns as developmental, such
physiologic function, nutritional/dietary, lifestyle
data relevant.
5. Relating family clinical/research to findings and
comparing patterns with standards of health.
6. Interpreting results based on how family
characteristics, values, attitudes, perceptions
lifestyle are associated with specific health
conditions or problems identified.
7. Making inferences or drawing conclusions
about the reasons for the existence of the
health condition or problem and risk factor
related to non-maintenance wellness state
which can be attributed to non- performance of
family health task.
STANDARD IN DETERMINING THE STATYS OF
FAMILY (3 TYPES)
1. Normal health of individual members-
involve physical, social and emotional
well-being of each family member.
2. Home and environmental conditions
conducive to health development- includes
the physical as well as the psychological
and socio-cultural milieu. (e.g. Type and
quality of housing, adequacy of living
space, the kind of sanitation)
3. Family characteristics, dynamics or level
of functioning conducive to family growth
and development. Constitutes the client's
ability a system to maintain its boundary
integrity achieve its purpose through a
dynamic interchange among its member
responding among its members while
responding to the external multi
environment.
FAMILY HEALTH TASKS
1. Recognize the presence of a wellness state or
health condition or problem.
2. Make decisions about taking appropriate
health action to maintain wellness or manage
the heal 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.
 The end result of data analysis during the first
level assessment is a conclusion or a
statement of a health condition or problem.
 The second level of analysis ends with a
definition of family nursing problems.
3. Formulation of Diagnosis
 Nursing Diagnosis -is a clinical judgement
about the family's response to actual or
potential health problems or life processes.
 The end result of the second level assessment
is a set family nursing problem.
 A wellness state family or health condition
becomes a nursing problem when it is stated
as the family's failure enhance to perform
adequate health tasks to the wellness state or
manage the health problem.
TYPOLOGY OF NURSING PROBLEMS IN FAMILY
NURSING PRACTICE
 Health tasks is the organizing framework of the
type of nursing care. In community health
nursing practice. The nurse deals with the
problems within the domain of human behavior
or human response to health and illness.
SIX CATEGORIES OF TYPOLOGY OF PROBLEMS
IN FAMILY CARE
 first wellness category -refers to the presence
of wellness state, health threats, health deficits
and foreseeable crisis or stress points.
 Five categories contain statements of the
family’s inability to perform the health tasks
The results of analysis of data taken during the second
level assessment
5 CATEGORIES 5. Spiritual Well-being
B. Readiness for Enhanced Capability for:
1. Inability to recognize the presence of the
1. Healthy lifestyle
condition/problem due to...
2. Health Maintenance
2. Inability to make decisions with respect to 3. Parenting Breastfeeding
4. Well-being
taking appropriate health action due to…
5. Spiritual
3. Inability to provide nursing care to the sick, I. Presence of Health Threats - condition that are
disabled, dependent or at-risk member of the conducive to disease and accident, or may rest failure
family due to... to maintain wellness or realize health por
4. Inability to provide a home environment which A. Presence of risk factors of specific disease
is conductive to health maintenance and case
personal development due to… B. Threat of communicable dis cross infection
5. Failure to utilize community resources for from a case.
health care due to… C. Family size beyond what family resources can
Nursing diagnosis consists of two parts: adequately provide
1. The statement of the unhealthy response D. Accident/ Fire hazards
2. The statement of factors Which are E. Faulty/Unhealthful nutritional/eating habits
maintaining undesirable response and F. Stress-provoking factors
preventing the desired change. G. Poor home/environmental condition/sanitation
H. Unsanitary food handling and preparation
TYPOLOGY OF NURSING PROBLEMS IN FAMILY
I. Unhealthful lifestyle and personal
NURSING PRACTICE
habits/practices
First-Level Assessment
J. Lack of immunization
I. Presence of Wellness Condition-stated
III. Presence of Health Deficits -instances of failure
as Potential judgement a or Readiness- a
health maintenance
clinical or nursing client in transition from a
A. Illness states, regardless of whether it is
specific level of wellness capability to a
diagnosed an undiagnosed
higher level.
B. Failure to thrive/develop according to normal
Wellness potential- is wellness a nursing
rate
judgment on performance, state client's or
C. Disability-whether congenital or arising from
condition based on but explicit current
illness, transient/temporary or permanent
Competencies or clinical data no
IV. Presence of Stress Points/Foreseeable
expression of client desire.
Crisis
Readiness for enhanced wellness state
Situations - anticipated periods of unusual dem on
is a nursing judgment on wellness state or
the individual or family in terms of a
condition based or client's current
adjustment/family resources; transitions
competencies or performance, clinical
A. Marriage
data and explicit expression of desire to
B. Pregnancy, labor
achieve a higher level of state area or
C. Parenthood
function in a specific health promotion and
D. Additional member
maintenance.
E. Entrance at school
A. Potential for Enhanced Capability for:
F. Divorce or separation
1. Healthy lifestyle
G. Loss of job. family member
2. Health Maintenance/Health
Management H. Hospitalization of a family member
3. Parenting
4. Breastfeeding
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 consequences of
diagnosis of problem
1. 1.Social stigma, loss of respect of peer
2. 2.economi/cost implications
3. physical consequences
emotional/psychological issues
4. life which hinders
C. Attitude/philosophy in
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 problem/condition
B. Low salience of the problem
C. Feeling of confusion/helplessness
D. Lack of/inadequate knowledge as to
alternative courses of action open to
them.
E. Inability to decide which action to take
among a list of alternatives.
F. Conflicting opinions among family
member.
G. Negative attitude towards the health
condition or problem.
H. Lack of trust/ confidence in the health
personnel/agency.
III. Inability to provide adequate nursing care to the
sick, disabled, dependent or vulnerable/risk
member of the family due to:
A. Lack of/inadequate knowledge about
the disease/health condition.
B. Lack of/inadequate knowledge about
child development and care.
C. Lack of/inadequate knowledge of the
nature and extend of nursing care
needed.
D. Lack of the necessary facilities,
equipment and supplies for care.
E. Inadequate family resources for care
1. absence of responsible member
2. financial constraints
3. limitations/lack of physical resources
F. Member's preoccupation with own
concerns/interest
G. Prolonged disease or disability
progression which exhausts
supportive capacity of family
members.
IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
A. Inadequate family resources
1. financial constraints/limited financial resources
2. limited physical resources e.g. lack of space to
construct facility
B. Failure to see benefits of investment in
home environment improvement
C. Lack of/ Inadequate knowledge of
importance 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
V. Failure to utilize community resources for health
ca 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. Unavailability of from the required
care/service
F. Feeling of alienation to/lack of support
from the community e.g. stigma due to
metal illness