Family Nursing Process

• Typology of Nursing
Problems in Family Nursing
Practice
First Level Assessment
• The process whereby existing and
potential health conditions or
problems of the family are determined.
• It relates what health problems exist
and will exist.
These health conditions are categorized as:
• Wellness State
• Health Threats
• Health Deficits
• Foreseeable Crisis
First Level Assessment
• Presence of Wellness Condition
* A clinical judgement about a client in
transition from a specific level of wellness or
capability to a higher level.
* Based on client’s performance, current
competencies, or clinical data or explicit
expression of desire to achieve a higher level of
state or function in a specific area on health
promotion and maintenance.
* May either be potential or readiness
Potential=showing the capacity to become
or develop into something in the future.
Readiness= the state of being fully
prepared for something, willingness to do
something.
Examples of this are the following
A. Potential for Enhanced Capability for:
1. Healthy lifestyle-e.g. nutrition/diet,
exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s
developing/unfolding of mystery through
harmonious interconnectedness that comes from
inner strength/sacred source/God (NANDA
2001)
6. Others, Specify.
B. Readiness for Enhanced Capability
for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others, Specify.
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 of this are the following:
A. Presence of risk factors of specific diseases
(e.g. lifestyle diseases, metabolic syndrome)
Lifestyle diseases are diseases linked with the way people live their life. Heart dse.,
stroke, obesity type 2 diabetes, smoking, alcohol, drug abuse. Poor lifestyle choices
such as smoking, overuse of alcohol, poor diet, lack of physical activity, inadequate
relief of chronic stress.
Metabolic syndrome is a group of five risk factors that increase the likelihood of
developing heart dse, diabetes, and stroke. Increased BP, high blood sugar levels,
excess of fat around the waist, high triglyceride levels, low levels of good cholesterol
HDL high density lipoprotein
B. Threat of cross infection from
communicable disease case

C. Family size beyond what family

resources can adequately provide
D. Accident hazards. Specify.
1. Broken chairs
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
4. Care-giving burden
G. Poor Home/Environmental
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. Unhealthy Lifestyle and Personal
Habits/Practices. Specify.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
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 rest or sleep
10. Lack of /inadequate exercise/physical
activity
11. Lack of/relaxation activities
12. Non-use of self-protection measures (e.g.
non use of bed nets in malaria and filariasis
endemic areas).

J. Inherent Personal Characteristics - e.g.

poor impulse control
K. Health history which may
participate/induce the occurrence of
health deficit, e.g. previous history of
difficult labor.
L. Inappropriate role assumption- e.g.
child assuming mother’s role, father not
assuming his role.
M. Lack of immunization/inadequate
immunization status specially of
children
N. Family disunity- e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits - instances of

failure in health maintenance.
Examples include:
A. Illness states, regardless of whether it is
diagnosed or undiagnosed by medical
practitioner.
B. Failure to thrive/develop according
to normal rate
Failure to thrive is defined as decelerated or arrested physical
growth (height and weight measurements fall below the third or
fifth percentile, or a downward change in growth across two major
growth percentiles) and is associated with abnormal growth and
development.
Signs:
Lack of appropriate weight gain.
Irritability.
Easily fatigued.
Excessive sleepiness.
Lack of age-appropriate social response (i.e., smile)
Does not make vocal sounds.
Delayed motor development.
Learning and behavior difficulties later in childhood.
C. Disability-whether congenital or
arising from illness; transient/temporary
(e.g. aphasia ( loss of ability to
understand or express speech) or
temporary paralysis after a CVA) or
permanent (e.g. leg amputation
secondary to diabetes, blindness from
measles, lameness from polio)
IV. Presence of stress points/foreseeable
crisis situations - anticipated periods of
unusual demand on the individual or
family in terms of adjustment/family
resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________
Second-Level Assessment
• Identifies the nature or type of nursing
problems that the family encounters in
performing the health tasks with respect to a
given health condition or problem, and the
etiology or barriers to the families’
assumption of these tasks.
• It explains the family’s problems related to
maintaining health and wellness.
• It specified the measures that the family
did not do due to Inability.
• Determine if the family recognizes the
existence of the condition or problem. If the
family does not recognize the presence of the
condition or problem, explore the reasons why.
• If the family recognizes the presence of the
condition or problem, determine if something
has been done to maintain the wellness state or
resolve the problem. If the family has not done
anything about it, determine the reasons why.
If the family has done something about the
problem or condition, determine if the solution
is effective.
• Determine if the family encounters other
problems in implementing the interventions
for wellness state/potential, health threat,
health deficit, or crisis. Identify these
problems.
• Determine how all the other members are
affected by the wellness state/potential, health
threat, health deficit, or stress point.
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, specifically:
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
D. Others. Specify _________
II. Inability to make decisions with respect
to taking appropriate health action due to:

A. Failure to comprehend the

nature/magnitude of the problem/condition
B. Low salience of the problem/condition
(refers to family’s perception and evaluation
of the problems in terms of seriousness and
urgency of attention needed.)
C. Feeling of confusion, helplessness
and/or resignation brought about by
perceive magnitude/severity of
the situation or problem, i.e. failure to
breakdown problems into manageable
units of attack.
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 consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition
or problem-by negative attitude is meant one that
interferes with rational decision-making.
J. Inaccessibility of appropriate resources for
care, specifically:
1. Physical Inaccessibility
2. Costs 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
M. Others, specify._________
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 or
extent of nursing care needed
D. Lack of the necessary facilities, equipment and
supplies of care
E. Lack of/inadequate knowledge or skill in
carrying out the necessary intervention or
treatment/procedure of care (i.e. complex
therapeutic regimen or healthy lifestyle
program).
F. Inadequate family resources of care
specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of /lack of physical resources
G. Significant persons unexpressed feelings
(e.g. hostility/anger, guilt, fear/anxiety,
despair, rejection) with 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 disabilities, which
exhaust supportive capacity of family
members.
K. Altered role performance, specify.
1. Role denials or ambivalence(the state of having
mixed feelings or contradictory ideas about something or someone)
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________
IV. Inability to provide a home environment
conducive to health maintenance and
personal development due to:
A. Inadequate family resources, specifically:
1. Financial constraints/limited financial
resources
2. Limited physical resources-e.g. lack of space
to construct facility
B. Failure to see benefits (specifically long
term ones) of investments 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 pattern within the
family
G. Lack of supportive relationship among family
members
H. Negative attitudes/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.
J. Others specify._________
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- e.g. loss of esteem of peer
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constraints
2. Physical inaccessibility
H. Lack of or inadequate family resources,
specifically;
1. Manpower resources - e.g. baby sitter
2. Financial resources - cost of medicines
prescribed
I. Feeling of alienation to/lack of support
from the community, e.g. stigma due to
mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life
which hinders effective/maximum
utilization of community resources for
health care
K. Others, specify __________
THANK YOU