TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE

FIRST-LEVEL ASSESSMENT
(A process whereby existing and potential health conditions or problems of the family are determined.)

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

judgment about a client in transition from a specific level of wellness or capability to a higher
level (NANDA, 2001).

Wellness potential is a nursing judgment 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 judgment 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 of these are the following:

A. Potential for enhanced capability for:

1. Healthy lifestyle – e.g. nutrition/diet, exercise/activity
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being – process of a client’s developing/unfolding of mystery
through harmonious interconnectedness that comes from inner strength/sacred
source/God (NANDA 2001)
6. Other, 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 these are:

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, specify:
1. broken stairs
2. pointed sharp objects, poisons, medicines improperly kept
3. fire hazards
4. fall hazards
5. others (specify) ____________________

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition 18
Prepared by: Leonora B. Cabanes, RN. June 2011.
 E. Faulty/unhealthful nutritional/eating habits or feeding techniques practices. Specify:
1. Inadequate food intake or certain nutrients
2. Excessive intake of specific 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 conditions/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 (e.g. mosquitoes,
flies, roaches, rodents, etc.)
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 footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self-medication or 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/inadequate relaxation activities
12. Non-use of self-protection measures (e.g. non-use of bed nets in malaria an
filariasis endemic areas)
J. Inherent personal characteristics – e.g. poor impulse control
K. Health history which may participate/induce the occurrence of a 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/inadequate immunization status specially of children
N. Family disunity, like:
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others, specify: ____________________________

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition 19
Prepared by: Leonora B. Cabanes, RN. June 2011.
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
C. Disability – whether congenital or arising from illness; transient/temporary (e.g. aphasia
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 or Foreseeable Crisis Situations – anticipated periods of unusual
demand on the individual or family in terms of adjustment/family resources. Examples
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 and death of a family member
L. Resettlement in a new community
M. Illegitimacy
N. Others, specify: ____________________________

SECOND-LEVEL ASSESSMENT
(Defines 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 family’s
assumption of these tasks.)

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

A. Lack of or inadequate knowledge

B. Denial about the 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 or psychological issues/concerns
C. Attitude or 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

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition 20
Prepared by: Leonora B. Cabanes, RN. June 2011.
 C. Feeling of confusion, helplessness, and/or resignation brought about by perceived
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 members/significant others regarding action to take
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of actions, specifically:
1. Social consequences
2. Economic consequences
3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards health condition or problem – negative attitude means one
that interferes with rational decision making
J. Inaccessibility of appropriate resources for care, specifically:
1. Physical inaccessibility
2. Cost constraints or financial/economic inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconception 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 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. complex therapeutic regimen or healthy lifestyle
program)
F. Inadequate family resources for care, specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitations/lack of physical resources, e.g. Isolation room
G. Significant person’s unexpressed feelings, (e.g., hostility/anger, guilt, fear/anxiety,
despair, rejection) which disable his/her capabilities 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
L. Others, specify: _______________________________

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition 21
Prepared by: Leonora B. Cabanes, RN. June 2011.
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 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 the
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 health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health personnel/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/significant others
F. Unavailability of required care/services
G. Inaccessibility of required care/service due to:
1. Cost constraints
2. Physical inaccessibility, i.e. location of facility
H. Lack of or inadequate family resources, specifically:
1. Manpower resources – e.g. baby sitter
2. Financial resources – e.g. cost of medicine 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 or maximum utilization of
community resources for health care
K. Others, specify: ______________________________________

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition 22
Prepared by: Leonora B. Cabanes, RN. June 2011.
 SAMPLE FAMILY NURSING CARE PLAN
Reference: Nursing Practice in the Community, Araceli S. Maglaya.5th Edition

INTERVENTION PLAN
HEALTH FAMILY NURSING GOAL OF CARE OBJECTIVES OF CARE METHOD OF RESOURCES
PROBLEM PROBLEMS NURSING INTEVENTIONS NURSE-FAMILY REQUIRED
CONTACT
1. Family Inability to make After nursing After nursing 1. Analyze with the couple Material resources:
size decisions with intervention, intervention, the critical issues related Home visit Visual aids on
beyond respect to taking the family will couple: with marital regulating fertility
what appropriate decide on a. Can explain what relationship and the
family health action due appropriate family planning is parent’s responsibility Human resources:
resources to lack of action(s) to all about for love and life as basis Time and effort of
can knowledge as to maintain family b. Can enumerate for maintaining family both nurse and the
adequatel alternative size based on a various ways of size family
y provide courses of action sense of maintaining the 2. Discuss with the couple
as a open to the family responsibility size of the family the alternative courses Financial resources:
health for love and life c. Will select a of action Money for the nurse’
deficit method most 3. Analyze with the couple transportation
appropriate for the advantages &
them disadvantages of each
d. Will consult the alternative/method to
nurse after encourage better
delivery for decision-making on the
guidance on the best option given the
alternative/metho family’s situation
d chosen 4. Explore with the family,
especially with the
couple ways of
encouraging growth-
promoting activities to
enhance marital
relationship for family
life education
5. Provide information on
the consultation hours
of the nurse

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition
23
Prepared by: Leonora B. Cabanes, RN. June 2011.
 SAMPLE FAMILY NURSING CARE PLAN
Reference: Nursing Practice in the Community, Araceli S. Maglaya.5th Edition

INTERVENTION PLAN
HEALTH FAMILY NURSING GOAL OF OBJECTIVES OF METHOD OF RESOURCES
PROBLEM PROBLEMS CARE CARE NURSING INTEVENTIONS NURSE- REQUIRED
FAMILY
CONTACT
2. Possible 1. Inability to recognize After nursing After nursing 1. Broaden the knowledge of Material
pre- the presence of intervention, intervention, the the family on complications Home visit resources:
eclampsi possible complication the family family will: of pregnancy, specifically: and clinic Visual aids, and
a as a in pregnancy due to will take the a. Ensure that a. Discuss the implications visit possibly,
health lack of knowledge necessary Mrs.A will have of the S/S presented by reagents, test
threat 2. Inability to provide measures to a regular Mrs. A tubes, burner,
adequate nursing care prevent or check-up at the b. Discuss the test tube
to a pregnant member properly clinic consequences of failure holder (if
due to: manage pre- b. Implement to take appropriate urinalysis will
a. Lack of knowledge eclampsia agreed upon action on the problem. be done by the
on the nature and health actions 2. Discuss with the family the nurse)
management of the for Mrs. A course of action open to
health condition and especially in them, and the consequences Time and effort
b. Lack of knowledge the areas of of the health actions on the of the nurse
on the nature and laboratory family and family
extent of nursing work-up, 3. Explore ways by which
care needed nutrition/diet, urinalysis can be done, either
3. Inability to utilize physical by having:
resources for health activity, rest a. A family member bring
care due to: and sleep, and the specimen to the
a. Failure to perceive general nearest lab & have the
benefits of health hygiene results available, or
care c. Decide on a b. The agency set-up its
b. Inaccessibility of the hospital own laboratory for
required service for delivery for simple tests especially if
urinalysis Mrs. A. accessibility of lab is a
major problem of most
clients in the community

Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition
24
Prepared by: Leonora B. Cabanes, RN. June 2011.
Reference: Nursing Practice in the Community. Araceli S. Maglaya. 2009. 5th Edition
Prepared by: Leonora B. Cabanes, RN. June 2011.