Unit II of NCM 31

Family Health Nursing Process

Part 2 (Diagnosing to Planning)
By:
Rowena M. Turtal, MAN, RN
CONTINUATION OF THE SEQUENCE OF ACTIVITIES IN FAMILY
NURSING PROCESS/PRACTICE
I. Establishing a working relationship with the family
II. ASSESSMENT- gathering information to determine the
presence of health problems
Note: the first two activities have been tackled in Family
Health Nursing Process Part I power point presentation.
SEQUENCE OF ACTIVITIES IN FAMILY NURSING PROCESS/PRACTICE…cont…

III. DIAGNOSING- Identifying the health problems/conditions and

categorize them according to its nature such as, health threats,
health deficits, stress points /foreseeable crises situations, and
wellness states. (Refer to the book by Maglaya, A. 2004)
Involves doing the following:
 categorizing the data according to clusters of related cues and
evidences which may support the presence of a problem
 analysis which reflects inferences about the family’s health
conditions and the explanations of the probable causes for the
identified conditions.
Categories of Health Problems (HPs) According to Nature
a. Wellness condition- stated as Potential or Readiness
-a clinical judgment about a client in transition from a specific
level of wellness or capability to a higher level)
Examples:
Potential or readiness for healthy lifestyle
Potential or readiness for breastfeeding
Potential or readiness for parenting
b. Health threats: health problems/conditions that are conducive to
disease, accident , or failure to realize one’s potential like:
unhealthy lifestyle, poor environmental sanitation, strained
marital relationship, and others.
• c. Health deficits: instances of failure in heath maintenance which
includes all illness states whether diagnosed by a doctor or
undiagnosed, delayed growth and development, and disability.

Examples: DM, Hypertension, measles, urinary problem, and

others.
d. Stress points or Foreseeable crises situations: anticipated
periods of unusual demand on family in terms of
adjustment/family resources.
Examples: marriage, birth, menopause, death and others
Note: For more examples of health problems, refer to
Typology of Nursing Problems 1st level assessment,
Maglaya, A. 2004. pp. 68-70.
 SEQUENCE OF ACTIVITIES IN FAMILY NURSING PROCESS/PRACTICE…cont…

IV. Come up with the family nursing problems (FNP) for each
health problem by determining the family’s ability/inability
to perform the five family health tasks (next slide pls.) on each
health problem
*To determine the FNP, use the two-part statement ( refer to
Typology of Nursing problems 2nd level assessment in Maglaya,
2004)
Examples:
a. Inability to provide nursing care to a sick member due to
inadequate knowledge on the condition
b. Failure to utilize community resources for health care due to
failure to perceive benefits of health care
c. Others
Family Health Tasks (Freeman, 1981 as cited by Maglaya,
2004)

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 health problem
3. Provide nursing care to the sick, disabled, dependent
or at risk members
4. Maintain a home environment conducive to health
maintenance
5. Utilize community resources for health care
SEQUENCE OF ACTIVITIES IN FAMILY NURSING PROCESS/PRACTICE…cont…

V. Priority Setting- Determine the priorities among the list

of problems based on criteria for establishing priorities
(signifies start of planning phase)

Criteria for determining priorities:

1. nature of the condition or problem presented
categorized into…
- wellness condition
- health threat
- health deficit
- foreseeable crises
Criteria for determining priorities, cont…

2. Modifiability of the condition or problem:

refers to the probability of success in…
- enhancing the wellness state
- improving the condition
- minimizing, alleviating or totally eradicating the problem
through interventions
 Criteria for determining priorities, cont…
3. Preventive Potential: refers to…
- the nature and magnitude of future problems
that can be minimized or totally prevented if the problem is
solved
4. Salience – refers to the family’s perception and evaluation of
the condition or problem in terms of :
- seriousness
- urgency of attention needed
- family readiness
Note: Refer to Maglaya,2004 for steps in computating of
 SCALE FOR RANKING WEIGHT
1. Nature of the condition or problem presented 1
Scale: Wellness state 3
Health deficit 3
Health threat 2
Foreseeable crisis 1
1. Modifiability of the condition or problem 2
Scale: Easily modifiable 2
Partially modifiable 1
Not modifiable 0
1. Preventive potential 1
Scale: High 3
Moderate 2
Low 1
1. Salience 1
Scale: A condition or problem, needing immediate attention 2
A condition or problem not needing immediate attention 1
Not perceived as a problem or condition needing change 0
Scoring:
1) Decide on a score for each of the criteria
2) Divide the score by the highest possible score and multiply by the weight:
(Score/Highest Score) X Weight
3) Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight
MALNUTRITION
Criteria Computation Actual Score Justification
1. Nature of the 3/3 x 1 1 Health deficit; requires immediate
problem management
1. Modifiability of 2/2 x 2 2 Easily modifiable; available
the problem resources; help family effective in
budgeting and time scheduling;
skill development for good
nutrition
1. Preventive 3/3 x 1 1 Susceptibility prevented through
potential elimination of malnutrition, thus
achieve normal growth and
development
1. Salience of the 0/2 x 1 0 Not a felt problem
problem
Total Score 4
IMPROPER REFUSE DISPOSAL
Criteria Computation Actual Score Justification
1. Nature of the 2x1 .66 Health deficit; requires immediate
problem management
1. Modifiability of 2/2 x 2 2 Easily modifiable; available
the problem resources; help family effective in
budgeting and time scheduling;
skill development for good
nutrition
1. Preventive 3/3 x 1 1 Susceptibility prevented through
potential elimination of malnutrition, thus
achieve normal growth and
development
1. Salience of the 0/2 x 1 0 Not a felt problem
problem
Total Score 3.66
 SEQUENCE OF ACTIVITIES IN FAMILY NURSING PROCESS/PRACTICE…cont…

VI. Create goals and objectives of care and develop

family nursing care plan (FNCP)
FNCP– refers to the set of actions that the health worker
will implement to be able to resolve identified family
health problems
*Goals- general statement of the condition or state to be
brought about by specific courses of action

e.g. At the end of three weeks, the family will be able to

take care of the premature infant competently.
*Objectives- specific statements of desired outcomes of
care
e.g. After health care intervention, the family will:
1. give sponge bath to the infant using the correct
technique.
2. feed the infant correctly per demand.
* Goals and objectives should be realistic and attainable
considering the resources of the nurse, family, and
community. The elements (ABCD) of an objective
should also be applied in the making of objectives for
the care of families.
 SEQUENCE OF ACTIVITIES IN FAMILY NURSING PROCESS/PRACTICE…cont…

VII. Plan approaches, strategies or interventions to

meet the set goals and objectives
These should be…
• aimed at minimizing or eliminating the reasons for or
causes of the family’s inability to do the health tasks
• Reflective of preventive, promotive, curative and
rehabilitative interventions
Types of interventions:

a. Supplemental- direct care activities

e.g. bathing, feeding, taking VS

b. Facilitative- removing barriers to health services e.g.

referrals, advocacy

c. Developmental- providing knowledge and skills e.g.

health teaching, skills training
*use of family strengths, resources, support system, and
community sources for assistance
 Interventions to Help the Family Perform the Health Tasks

1. Help the family recognize the problem

2. Guide the family on how to decide on appropriate health actions to
take
3. Develop the family’s ability and commitment to provide nursing
care to its members
4. Enhance the capability of the family to provide a home
environment conducive to health maintenance and personal
development
5. Facilitate the family’s capability to utilize community resources for
health care
e.g. health teachings, referrals, skills training
 References
• Allender, J. A., Rector, C. , & Warner, K.. (2014). Community and public
health nursing promoting the public’s health. 8th ed. Philadelphia:
Lippincott Williams &Wilkins.

• Famorca, Z. U., Nies, M. A., & McEwen, M.. (2013 or 2018). Nursing care of
the community: A comprehensive text on community and public health
nursing in the Philippines. Singapore: Elsevier Mosby.

• Maglaya, Araceli. (ed) (2004 or 2009). Nursing Practice in the Community.

Mla. Argonauth Co.

• Note: Several authors that have been mentioned in the presentation are
cited by the above-mentioned references.
God bless!!!