FAMILY NURSING PROCESS
Community Health Nursing | Glenda Fronteras | BSN 2P
Objectives:
1. Define the family nursing process
2. Determine the steps for Assessment
3. Distinguish First Level Assessment from Second
Level Assessment
4. Identify Health Problems of a Family
5. Interpret data related to the identified health
condition
6. Formulate a plan of care to address the health
conditions, needs, problems, and issues based
on priorities
7. Determine Barriers to Joint Setting of Goals
Definition
 Family Nursing Process
o The blueprint in the care that the nurse
design to systematically minimize or
eliminate 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 and tools.
o A systematic approach of solving an
existing problem/meeting the needs of
family
FAMILY NURSING PROCESS
Mnemonic: RAPIE
1. RAPPORT
o Trust building
o Knowing your client
o Adjusting to the situation and
environment
o RESPECT
2. ASSESSMENT
o First major phase of nursing process
o Involves a set of action by which the
nurse measures the status of the
family as a client. Its ability to maintain
wellness, prevent, control or resolve
problems in order to achieve health and
wellness among its members
o Data about present condition or status
FAMILY HEALTH ASSESSMENT: Tools for
of the family are compared against the
Assessment
norms and standards of personal,
 Initial Data Base (IDB)
social, and environmental health,
system integrity and ability to resolve
social problems
o The norms and standards are derived
from values, beliefs, principles, rules
or expectation
DATA COLLECTION METHODS
 Observation
o The family’s health status can be
inferred from the s/sx of problem
areas
A. communication and
interaction patterns
expected, used, and tolerated
by family members
B. role perception/task
assumption by each
member including decision
making patterns
C. conditions in the home and
environment
 Physical Examination
o Significant data about the health
status of the individual members can
be obtained through direct
examination through IPPA
o Measurement of specific body parts
and reviewing the body systems
o Data gathering from PE form
substantial first level assessment
which may indicate the presence of
health deficits (illness status)
 Interview
o Productivity of interview process
depends upon the use of effective
communication techniques to elicit
needed response of PROBLEMS
ENCOUNTERED
 Records Review
o E.g. laboratory or diagnostic tests?
o Gather information through reviewing
existing records and reports
pertinent to the client
o Individual clinical records of the family
member, laboratory and diagnostic
records, immunization records
report about house and
environmental condition
TYPOLOGY OF NURSING PROBLEM
 FIRST LEVEL ASSESSMENT
o To determine problems of family
o Sources or Problems using IDB
o Family: use of Initial Data Base (IDB)
o Nature: Health Deficit (HD), Health
Threat (HT), Foreseeable Crisis (FC)
 SECOND LEVEL ASSESSMENT
o Defines the nature or type of
nursing problem that family
encounters in performing health
task with respect to given health
condition or problem and etiology or
barriers to the family’s assumption of
task
o Family structure characteristics and
dynamics
 Members of the household and
relationship to the head of the
family
 Demographic data-age, sex,
civil status, position in the family
 Place of residence of each
member – whether living with
the family or elsewhere
 Type of family structure – e.g.
patriarchal, matriarchal, nuclear
or extended
 Dominant family members in
terms of decision making
especially on matters of health
care
  General family
relationship/dynamics –
presence of any obvious/readily
observable conflict between
members; characteristics,
communication / interaction
patterns among members
o Socio-economic and cultural factors
 Income and expenses
 Occupation, place of
work and income of
each working member
 Adequacy to meet basic
necessities (food,
clothing, shelter)
 Who makes decision
about money and how it
is spent
 Educational Attainment of each
member
 Ethnic background and
Religious Affiliation
 Significant others – role(s) they
play in family’s life
 Relationship of the family to
larger community – nature and
extent of participation of the
family in community activities
o Home and environment factors
 Information on housing and
sanitation facilities, kind of
neighborhood and availability of
social, health, communication
and transportation facilities
 Housing
 Adequacy of living
space
 Sleeping in
arrangement
 Presence of breathing
or resting sites of vector
of diseases (e.g.
mosquitoes, roaches,
flies, rodents etc.)
 Presence of accident
hazard
 Food storage and
cooking facilities
 Water supply – source,
ownership, pot ability
 Toilet facilities – type,
ownership, sanitary
condition
 Garbage/refuse
disposal – type, sanitary
condition
 Drainage system – type,
sanitary condition
 Kind of neighborhood, e.g.,
congested, slum etc.
 Social and Health facilities
available
 Communication and
transportation facilities available
ADEQUACY OF LIVING SPACE
Formula:
 TFA (in sqm) = Length of the house x
width of the house
 TSR = number of household members x
corresponding space required for that
member
Consider:
 Adults (13 y/o and above ) = 15 sqm
 Children (1 y/o to 12 y/o) = 8 sqm
 Infants (below 12 months) = 0 sqm
Compare the TFA (total floor area) with the TSR
(total space requirement)
Crowded if: TFA < TSR
Not Crowded if: TFA > TSR
Example:
 TFA = 21 sqm
 TSR = 2(15) + 3(8)
 =30+24
 =54
21 < 54
TFA < TSR
Interpretation: TFA <TSR (crowded)
TYPES OF MATERIAL USED FOR HOUSE
 Light
 Refers to such materials as bamboo, nipa,
sawali, coconut leaves, or card board
 Strong
 Refers to predominantly concrete house
 Mixed
 Refers to a combination of light materials
wood and/or concrete
 Typically concrete floor and foundation and
light walls or a concrete 1st floor and a light 2nd
floor
LIGHT FACILITIES
 Artificial means of providing light/illumination
 Facilities used already reflect adequacy and
safety for the family
 Example: electricity, kerosene, candles or none
APPROVED TYPE OF WATER FACILITIES
o Level I (Point Source)
 A protected well or a developed
spring with an outlet but without
a distribution system
 Indicated for rural areas where
houses are scattered
 Serves 15-25 household; its
outreach is not more than 250m
from the farthest user
 Yields 40-140 L/m
o Level II (Communal Faucets or Stand
Posts)
 With a source, reservoir, piped
distribution network and
communal faucets
 Located at not more than 25m
from the farthest house
  Delivers 40-80L of water per
capital per day to an average of
100 households
 Serves 4-6 household per
faucet
 Fit for rural areas where houses
are densely clustered
o Level III (Individual House
Connections or Waterworks System)
 With a source, reservoir, piped
distribution network and
household taps
 One or more faucets per
household
 Fit for densely populated urban
communities
TYPE OF EXCRETA DISPOSAL
 Level I
o Non water carriage toilet facility
 No water necessary to flush the
waste into the receiving space
 Example: pit latrines, bored-hole
latrines
o Toilet facilities requiring small amount of
water to wash the waste into the
receiving space
 Example: pour flush toilet and
aqua privies
o Pail System
 A pail or box is used to receive
excreta and dispose later when
filled
 Include ballot system where in
excreta is wrapped in a piece of
paper/plastic and thrown later
o Open Pit Privy/Latrine
 Consist of a pit covered with a
platform with a hole and is
usually not covered
 The platform may, in its simplest
form, consist only of 2 pieces of
wood or bamboo
o Closed Pit Privy/Latrine
 A pit privy in which the hole over
the platform is provided with a
cover
o Type of pit include:
 Ventilated improved pit (VIP)
 Pit with a vent pipe
 Reed Odorless Earth Closet
(ROEC)
 A pit completely
displaced from the
superstructure and
connect to the squatting
plate by a curved chute
 Antipolo Type
 Toilet house is elevated
and the shallow pit is
extended upwards to
the platform (toilet floor)
by means of a chute or
pipe made of metal,
clay, aluminum or board
 Bored-Hole Latrine
 Toilet consist of a deep
(usually more than 10
feet) but relatively
narrow (less than 2
meters in diameter) hole
made with boring
equipment
 Overhung Latrine
 Toilet house is
constructed over a body
of water (stream, lake,
and river) into which
excreta is allowed to fall
freely
 Level II
o On site toilet facilities of the water
carriage type with water-sealed and
flush type with septic vault/tank disposal
o Flush Type
 A toilet system where waste is
disposed by flushing water
through the pipes (sewers) into
the public sewerage system or
into an individual disposal
system like an individual septic
tank
o Water Sealed Latrine
 An Antipolo type of toilet, bored-
holed latrine, or any pit privy
wherein water sealed toilet bowl
is placed instead of the simple
platform hole (+) septic tank
 Level III
o Water carriage types of toilet facilities
connected to septic tanks and/or
sewerage system to treatment plant
SEWERAGE SYSTEM
 Blind Drainage
o Waste water flows through a system of
closed pipes to an underground pit or
covered canal
 Open drainage
o Waste water flows through a system of
pipes (could be improvised from
bamboo) to an open pit canal
 None
o When no drainage system or container
used for garbage. Waste water from the
kitchen flows directly to the ground,
oftentimes forming a nearly permanent
pool. Garbage is not put in a container
when disposed.
TYPES OF WASTE DISPOSAL
 Hog feeding
o Garbage is used as hog feed and also
to chicken and other livestock
 Open Dumping
o Refuse and/or garbage piled in a
dumping place (with or without pit) with
no soil covering
 Open burning
o Regularly piles refused/garbage and
later burned in open air. This is
uncontrolled burning which is usually
done for yard and street sweeping. It
may be allowed in rural areas where it
will not worsen already existing air
pollution
 Burial pit and contributing modifiable risk
o Refuse/garbage places in a pit and factors for specific lifestyle
covered when filled up. There is no diseases
intention to dig it up later for use as  Hypertension, physical
fertilizer. This should be located 25 inactivity, sedentary
METERS AWAY from any well used for lifestyle,
water supply. cigarette/tobacco
 Composting smoking, elevated blood
o Involved buying or stacking of lipids/cholesterol,
alternating layers of organic based obesity, diabetes
refuse/garbage and treated soil mellitus, inadequate
arranged as to hasted rapid decay and fiber intake, stress,
decomposition into compost. alcohol drinking, and
o This organic mixture can be later be other substance abuse
used as fertilizer  Physical assessment indicating
 Garbage collection presence of illness state/s
o Refuse/garbage collected by truck and (diagnosed or undiagnosed by
medical practitioners)
any type of garbage collected in the
 Results of laboratory/diagnostic
community
and other screening procedure
supportive of assessment
findings
o Health assessment of each member

 Medical nursing history
o Value placed on prevention of
indicating current or past
significant illnesses or beliefs disease (Values health practices on
and practices conducive to health promotion, maintenance and
health and illness disease prevention)
 Nutritional assessment  Immunization status of family
(especially for vulnerable or at members
risk members)  Healthy lifestyle practices
 Specify adequacy of:
 Anthropometric data:
measures of nutritional  Rest and sleep
status of children  Exercise/activities
 Weight, height, mid-  Use of protective
upper arm measure
circumference;  E.g. adequate footwear
 Risk assessment in parasite-infested
measures for obesity areas; use of bed nets
o BMI and protective clothing
o Waist in malaria and filariasis
endemic areas
circumference
(WC: >90 cm in  Relaxation and other
men and >80 stress management
cm in women) activities
o Waist hip ratio  Use of promotive-preventive
health services
(WHR = waist
circumference
in cm / hip
TOOLS USE IN FAMILY HEALTH ASSESSMENT
circum. in cm)
 Family health assessment form
o Central obesity:
o Is a guide in data collection as a means
WHR >= 1.0 cm
in men and 0.85 to record pertinent information about the
in women family that will assist the nurse in
working with family.
 Dietary history
 Genogram
specifying quality and
quantity of food or o Helps the nurse outline the family’s
nutrient intake per day structure. It is a way to diagram the
 Eating/feeding family. Three generations of family
habits/practice members are included with symbols
 Developmental assessment of denoting genealogy
infant, toddlers and  Ecomap
preschoolers o A classic tool that is used to depict a
 E.g. Metro Manila family’s linkages to its suprasystem
Developmental o Portrays an overview of the family in
Screening Test their situation; it depicts the important
(MMDST) nurturant of a conflict laden connection
 Risk factor assessment between the family and the world. It
indicating presence of major
 demonstrates the flow of resources or function in a
the lacks and deprivation specific area on
o A mapping procedure that highlights the health
nature of the interfaces and points to promotion and
conflicts to be mediated, bridges to built, maintenance
and resources to be sought and I. PRESENCE OF WELLNESS CONDITION
mobilized A. Potential for enhanced capability for:
 Healthy lifestyle – eg nutrition/diet,
exercise/activity
 Health maintenance/health management
FAMILY HEALTH ASSESSMENT: Typology of  Parenting
Nursing Problems in Family Nursing Practice  Breastfeeding
 Spiritual well-being – process of client’s
 First Level Assessment developing/unfolding of mystery through
harmonious interconnectedness that comes
o Categorize if:
from inner strength/sacred source/God
 Presence of wellness condition (NANDA, 2001)
 Stated as potential or  Others. Specify _____
readiness
 A clinical or nursing B. Readiness for enhanced capability for:
judgment about a client  Healthy lifestyle
in transition from a  Health maintenance/health management
specific level of  Parenting
wellness or capability to  Breastfeeding
a higher level  Spiritual well-being
 Wellness potential  Others. Specify ____
o Is a nursing _
judgment on
wellness state  Presence of health threat
or condition  Conditions that are
based on conducive to disease
client’s and accident or may
performance, result to failure to
current maintain wellness or
competencies, realize health potential
or clinical data  Family is health but
BUT NO there are risks
EXPLICIT o HICE
EXPRESSION o Hazards
OF DESIRE to o Inadequate/
achieve a lack of
higher level of immunization
state or function o Cross infection
in a specific o Environmental
area on health sanitation is
promotion and poor
maintenance.
 Examples are ff:
 Readiness for o Presence of risk
Enhanced Wellness
factors of
state
specific
o Is a nursing
diseases (e.g.
judgment on lifestyle
wellness state diseases,
or condition metabolic
based on syndrome)
client’s o Threat of cross
performance, or
infection from
condition based
communicable
on client’s
disease case
current
o Family size
competencies
beyond what
or performance
family
clinical data or
resources can
EXPLICIT
adequately
EXPRESSION
provide
OF DESIRE TO
o Accident
ACHIEVE A
hazards specify
HIGHER
 Broken
LEVEL OF
chairs
STATE or
  Pointed/  Polluted
sharp water
objects, supply
poisons  Presence of
and breeding or
medicines resting
improperly sights of
kept vectors of
 Fire diseases
hazards  Improper
 Fall garbage/ref
hazards use
 Others disposal
specify  Unsanitary
o Faulty/ waste
unhealthful disposal
nutritional/eatin  Improper
g habits or drainage
feeding system
techniques/prac  Poor
tices. Specify lighting and
 Inadequate ventilation
food intake  Noise
both in pollution
quality and  Air pollution
quantity o Unsanitary food
 Excessive handling and
intake of preparation
certain o Unhealthy
nutrients lifestyle and
 Faulty Personal
eating Habits/Practice
habits s. Specify
 Ineffective  Alcohol
breastfeedi drinking
ng  Cigarette/
 Faulty tobacco
feeding smoking
techniques  Walking
o Stress barefooted
provoking or
factors. Specify inadequate
 Strained footwear
marital  Eating raw
relationship meat or fish
 Strained  Poor
parent- personal
sibling hygiene
relationship  Self
 Interperson medication/
al conflicts substance
between abuse
family o Inherent
members personal
 Care-giving characteristics
burden  Poor
o Poor impulse
Home/Environm control
ental o Health history,
Condition/Sanit which may
ation. Specify. participate/indu
 Inadequate ce the
living space occurrence of
 Lack of health deficit
food  Previou
storage s
facilities history
of
 difficult  Disability – whether congenital or arising from
labor illness; transient/temporary
o Inappropriate
role assumption
 Child 
Presence of stress
assumi points/foreseeable crisis
ng  Anticipated periods of
mother’ unusual demand on the
s role, individual or family in
father terms of
not adjustment/family
assumi resources
ng his  Anything which is
role anticipated/expected to
o Lack of become a problem
immunization/in  SACCIPDA
adequate  S-chool entrance
immunization  A-dolescents
status specially  C-ourtships and
of children marriage
o Family disunity  C-ircumcision
 Self-oriented  I-llegitimacy
behavior of  P-regnancy
member(s)
 D-eath
 Unresolved
 A-ddiction
conflicts of
EXAMPLES OF PRESENCE OF STRESS
member(s)
POINTS/FORESEEABLE CRISIS SITUATIONS
 Intolerable
 Marriage
disagreemen
 Pregnancy, labor, puerperium
t
 Parenthood
o Others. Specify
 Additional member e.g. newborn, lodger
____  Abortion
 Entrance at school
 Presence of health deficits  Menopause
 Instances of failure in  Loss of job
health maintenance  Hospitalization of a family member
 If identified problem is  Death of a member
an abnormality, illness  Resettlement
or disease, there’s a  Adolescence
gap/difference between  Divorce or separation
normal status (ideal,  Resettlement in a new community
desirable, expected) &  Illegitimacy
actual status (the  Others, specify _____
outcome/result/problem
encountered on the
actual day)
 Illness states,
regardless of whether it
is diagnosed or not by
medical practitioner
 Failure to
thrive/developmental
according to normal rate
 Disability – whether
congenital or arising
from illness; temporary
 4Ds
o Disease
o Disorder
o Disability
o Developmental  Second Level Assessment
problems I. INABILITY TO RECOGNIZE THE
EXAMPLES OF PRESENCE OF HEALTH DEFICITS PRESENCE OF THE CONDITION OR
 Illness states, regardless of whether it is PROBLEM DUE TO:
diagnosed or undiagnosed by medical  Lack of or inadequate knowledge
practitioner  Denial about its existence or severity as a
 Failure to thrive/develop according to normal result of fear of consequences of diagnosis of
rate problem, specifically:
-social-stigma, loss of respect of peer/significant
others
-economic/cost implications
-physical consequences
-emotional/psychological issues/concerns
 Attitude/philosophy in life, which hinders
recognition/acceptance of a problem
 Others. Specify ____
II. INABILITY TOMAKE DECISIONS WITH
RESPECT TO TAKING APPROPRIATE
HEALTH ACTION DUE TO:
 Failure to comprehend the nature/magnitude
of the problem/condition
 Low salience of the problem/condition
 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
 Lack of/inadequate knowledge/insight as to
alternative courses of action open to them
 Inability to decide which action to take from
among a list of alternatives
 Conflicting opinions among family
members/significant others regarding action
to take.
 Lack of/inadequate knowledge of community
resources for care
 Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
 Negative attitude towards the health condition
or problem – by negative attitude is meant
one that interferes with rational decision-
making
 Inaccessibility of appropriate resources for
care, specifically:
1. Physical inaccessibility
2. Costs constraints or economic/financial
inaccessibility
 Lack of trust/confidence in the health
personnel/agency
 Misconceptions or erroneous information
about proposed course(s) of action
 Others specify ____
III. INABILITY TOPROVIDE ADEQUATE
NURSING CARE TO THE SICK, DISABLED,
DEPENDENT OR VULNERABLE/AT RISK
MEMBER OF THE FAMILY DUE TO:
 Lack of/inadequate knowledge about the
disease/health condition (nature, severity,
complications, prognosis and management)
 Lack of/inadequate knowledge about child
development and care
 Lack of/inadequate knowledge of the nature
or extent of nursing care needed
 Lack of the necessary facilities, equipment
and supplies of care
 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)
 Inadequate family resources of care
specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
 Significant persons unexpressed feelings (e.g.
hostility/anger, guilt, fear/anxiety, despair,
rejection) which his/her capacities to provide
care
 Philosophy in life which negates/hinder caring
for the sick, disabled, dependent,
vulnerable/at risk member
 Member’s preoccupation with on
concerns/interests
 Prolonged disease or disabilities, which
exhaust supportive capacity of family
members
 Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
 Others. Specify ____
IV. INABILITY TOPROVIDE A HOME
ENVIRONMENT CONDUCIVE TO HEALTH
MAINTENANCE AND PERSONAL
DEVELOPMENT DUE TO:
 Inadequate family resources specifically:
1. Financial constraints/limited financial
resources
2. Limited physical resources – i.e. lack of space
to construct facility
 Failure to see benefits (specifically long term
ones) of investments in home environment
improvement
 Lack of/inadequate knowledge of importance
of hygiene and sanitation
 Lack of/inadequate knowledge of preventive
measures
 Lack of skill in carrying out measures to
improve home environment
 Ineffective communication pattern within the
family
 Lack of supportive relationship among family
members
 Negative attitudes/philosophy in life which is
not conducive to health maintenance and
personal development
 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.
 Others specify ____
V. FAILURE TO UTILIZE COMMUNITY
RESOURCES FOR HEALTH CARE DUE TO:
 Lack of/inadequate knowledge of community
resources for health care
 Failure to perceive the benefits of health
care/services
 Lack of trust/confidence in the
agency/personnel
 Previous unpleasant experience with health
worker
 Fear of consequences of action (preventive,
diagnostic, therapeutic, rehabilitative)
specifically:
1. Physical/psychological consequences
2. Financial consequences
 3. Social consequences
 Unavailability of required care/services
 Inaccessibility of required services due to:
1. Cost constraints
2. Physical inaccessibility
 Lack of or inadequate family resources,
specifically
1. Manpower resources, eg baby sitter
2. Financial resources, cost of medicines
prescribe
 Feeling of alienation to/lack of support from
the community
e.g. stigma due to mental illness, AIDS, etc.
 Negative attitude/philosophy in life which
hinders effective/maximum utilization of
community resources for health care
 Others, specify ____

3. PLANNING
4. INTERVENTION
5. EVALUATION