NURSING ASSESSMENT IN

FAMILY NURSING PRACTICE

 First major phase of the nursing
process.

In family health practice, this

involves:
NURSING • A set of actions by which the nurse
measures the status of the family as a
ASSESSMENT client.
• Its ability to maintain itself as a system and
functional unit
• Its ability to maintain wellness, prevent,
control or resolve problems in order to
achieve health and well-being among its
members.
 NURSING ASSESSMENT INCLUDES:
1. DATA COLLECTION
2. DATA ANALYSIS OR
INTERPRETATION
3. PROBLEM DEFINITION OR
NURSING
DIAGNOSIS

• Nursing Diagnosis
- end result of two
major types of nursing
assessment in family
nursing practice.
These are:

1. First Level Assessment

2. Second Level
Assessment
 • A process whereby existing and potential
health condition or problems of the family
are determined.
FIRST LEVEL • These are:
1. Wellness state/s
ASSESSMENT 2. Health Threats
3. Health Deficits and
4. Stress points or foreseeable crisis situations
 • Defines the nature or type of nursing
SECOND problems that the family encounters in
performing the health tasks with respect to
LEVEL a given health condition or problem, and
ASSESSMENT the etiology or barriers to the family’s
assumption of these tasks.
Steps in Family Nursing Assessment

• Data Collection
• In first level assessment involves gathering
of five types of
• data which will generate the categories
of health
• conditions or problems of the family.

• These data includes:

• 1. Family Structure, Characteristics and
dynamics;
• 2. Socio-economic and cultural
characteristics;
• 3. Home and Environment;
• 4. Health Status of each member; and
• 5. Values and practices on
health-on-health promotion/maintenance
and disease prevention
In second level assessment data include:

• Those that specify or describe the family’s

realities, perceptions about and attitude related
to the assumption or performance of family
health tasks on each health condition or problem
identified during the first level assessment.
2. Data Analysis
Involves several sub-steps:
1. Sorting of Data
2. Clustering of Related Cues
3. Distinguishing relevant from
irrelevant data
4. Identifying Patterns
5. Comparing Patterns with norms
or standards
6. Interpreting results
7. Making Inferences/Draw
conclusions
3. Nursing Diagnosis

• These includes two types:

1. The definition of wellness state/potential

or health condition or problems as an end product of first
level of assessment, and

2. The definition of family nursing problems as an end

result of second level assessment.

• The family nursing problems is stated as an inability to

perform a specific health task and the reasons (etiology)
why the family cannot perform such task.
DATA COLLECTION
• The nurse is concerned about two important things to
ensure effective and efficient data collection in family
nursing practice.
1. Identify the types or kinds of data needed.
2. Specify the methods of data-gathering and
the necessary tools to collect such data.
 • Two Types of data needed at two levels of
assessment in family nursing practice.
1. Initial Data Base – taken during the first
level assessment
TYPES OF DATA • These data includes:

IN FAMILY 1. Family Structure, Characteristics and

dynamics; - include the composition
NURSING and demographic data of the
members of the family/household, their
ASSESSMENT relationship to the head and place of
residence; the type of, and family
interaction/communication and
decision-making patterns and
dynamics.
2. Socio-economic and cultural characteristics; - include
occupation, place of work, and income of each
working member; educational attainment of each
family member; ethnic background and religious
affiliation; significant others and the other roles they
play in the family’s life; and, the relationship of the
family to the larger community.
3. Home and Environment; - include information on
housing and sanitation facilities; kind of neighborhood
and availability of social, health, communication and
transformation facilities in the community.
4. Health Status of each member; - includes current and
past significant illness; belief and practices conducive
to health and illness; nutritional and developmental
status; physical assessment findings and significant
results of laboratory/diagnostics test/screening
procedures.
5. Values and practices on health on health
promotion/maintenance and disease prevention – include
use of prevention services; adequacy of rest/sleep,
exercise, relaxation activities, stress management or
other healthy lifestyle activities, and immunization status
of at-risk family members.
2. Reflects the extent to which the family can perform
the health tasks on each condition or problem
These includes:

1. The family’s perception of the problem;

2. Decisions made and appropriateness; if none,
reasons, and
3. Actions taken and results; if none, reasons; and,
4. Effects of decisions and actions on other family
members.
 • There are several methods of
data-gathering that the nurse
can select from depending on
availability of resources such
DATA – as:
GATHERING ❖ Material
METHODS AND
❖ Manpower
TOOLS
❖ Time
❖ Facilities
 Done using
sensory
capacities such
1. Observation as:
• Sight
• Hearing
• Smell
• Touch
METHOD OF
DATA Done through:
COLLECTION • - Inspection
• - Palpation
• - Percussion
2. Physical • - Auscultation
Examination • - Measurement of
specific body parts and
reviewing the
• body systems
 - Completing a health history for each family member

3. Interview

- 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 and the corresponding
nursing problems for each health condition or
problem.

4. Record Review

5. Laboratory/Diagnostic Tests
 • I. Presence of Wellness Condition -
stated as potential or Readiness-a
clinical or nursing judgment about
a client in transition from a specific
A TYPOLOGY level of wellness or capability to a
OF NURSING higher level. Wellness potential is a
nursing judgment on wellness state
PROBLEMS IN or condition based on client’s
FAMILY performance, current
NURSING competencies, or performance,
clinical data or explicit expression
PRACTICE of desire to achieve a higher level
of state or function in a specific
area on health promotion and
maintenance. Examples of this are
the following
• 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.
• III. Presence of health deficits -
instances of failure in health
maintenance.
• IV. Presence of stress
points/foreseeable crisis
situations-anticipated periods of
unusual demand on the individual
or family in terms of
adjustment/family resources.
Second-Level Assessment

• I. Inability to recognize the presence

of the condition or problem due to:
• II. Inability to make decisions with
respect to taking appropriate health
action due to:
• III. Inability to provide adequate
nursing care to the sick, disabled,
dependent or vulnerable/at risk
member of the family due to:
• IV. Inability to provide a home
environment conducive to health
maintenance and personal
development due to:
 • Purpose:
•  To provide a basis for estimating the
nursing needs of a particular family.

• Health Care Need

FAMILY • A family health care need is present
COPING when:
INDEX • 1. The family has a health problem
with which they are unable to cope.
• 2. There is a reasonable likelihood that
nursing will make a difference in the in
the family’s ability to cope.
 •  COPING may be defined as
dealing with problems associated
RELATION TO with health care with reasonable
COPING success.
NURSING •  When the family is unable to
NEED: cope with one or another aspect of
health care, it may be said to have
a “coping deficit”
 • Two parts of the Coping index:
1. A point on the scale
2. A justification statements
• The scale enables you to place the family
in relation to their ability to cope with the
nine areas of family nursing at the time
observed and as you would expect it to
be in 3 months or at the time of discharge
DIRECTION if nursing care were provided. Coping
FOR SCALING capacity is rated from 1 (totally unable to
manage this aspect of family care) to 5
(able to handle this aspect of care
without help from community sources).
Check “no problem” if the category is not
relevant to the situation.
• The justification consists of brief statement
or phrases that explain why you have
rated the family as you have.
 1. It is the coping capacity and not the
underlying problem that is being rated.
2. It is the family and not the individual that is
being rated.
3. Rating should be done after 2-3 home visits
when the nurse is more acquainted with the
family.
4. Justification- a brief statement that explains
why you have rated the family as you have.
GENERAL These statements should be expressed in
terms of behavior of observable facts.
CONSIDERATIONS Example: “Family nutrition includes basic 4
rather than good diet.
5. Terminal rating is done at the end of the given
period. This 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.
 •The following descriptive
statements are “cues” to help
you as you rate family coping.
SCALING CUES They are limited to three points
– 1 or no competence, 3 for
moderate competence and 5
for complete competence.
 • 1. Physical independence: This
category is concerned with 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.
• 2. Therapeutic Competence: This
AREAS TO BE category includes all the procedures
or treatment prescribed for the care
ASSESSED of ill, such as giving medication,
dressings, exercise and relaxation,
special diets.
• 3. Knowledge of Health Condition:
This system is concerned with the
health condition that is the occasion
of care
• 4. Application of the Principles of
General Hygiene: This is concerned
with the family action in relation to
maintaining family nutrition, securing
adequate rest and relaxation for family
members, carrying out accepted
preventive measures, such as
immunization.
• 5. Health Attitudes: This category is
concerned with the way the family
feels about health care in general,
including preventive services, care of
illness and public health measures.
• 6. Emotional Competence: This
category has to do with the maturity
and integrity with which the members
of the family can meet the usual
stresses and problems of life, and to
plan for happy and fruitful living.
• 7. Family Living: This category is
concerned largely with 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.
• 8. Physical Environment: This is
concerned with the home, the
community, and the work
environment as it affects family
health.
• 9. Use of Community Facilities:
generally, keeps appointments.
Follows through referrals. Tells others
about Health Departments services
 Area of Assessment Score Justification
1. Physical independence

2. Therapeutic Competence

3. Knowledge of Health Condition

4. Application of the Principles of

General Hygiene
5. Health Attitudes

6. Emotional Competence

7. Family Living Patterns

8. Physical Environment

9. Use of Community Facilities