University of San Agustin

College of Health and Allied medical Professions

Nursing Program

FAMILY NURSING PROCESS:

Includes data collection, data analysis or interpretation and problem definition
or nursing diagnosis
The rationale for adopting this health tasks as the framework of the typology is
the fact that in community health nursing practice, one deals mostly with
problems within the domain of human behavior or human response to health
and illness.
A community health nurse works with and through the family to improve its
behavior related to health.

ASSESSMENT AND DIAGNOSES IN FAMILY NURSING PRACTICE

There are two major types in dealing with the assessment of the family
according to nursing practice:

1. FIRST LEVEL ASSESSMENT

- the process of determining existing and potential health conditions or
problems of the family. These health conditions are categorized as:

A. 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.

A. Potential or Capability for: B. Readiness for Enhanced Capability

for:
• Healthy Lifestyle – e.g. nutrition, • Healthy Lifestyle
diet, exercise, activity • Health Maintenance/ Health
• Health Maintenance/ Health Management
Management • Parenting
• Parenting • Breastfeeding
• Breastfeeding • Spiritual Well-being
• Spiritual Well-being Others
Others
B. HEALTH THREATS
- Conditions that are conducive to disease and accident, or may result to failure
to maintain wellness or realize health potential
A. Presence of risk factors of specific diseases
B. Threat of cross infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident/ fire hazards
E. Faulty/ unhealthful nutritional/ eating habits or feeding techniques or
practices
F. Stress provoking factors
G. Poor home environmental condition/ sanitation
H. Unsanitary food handling and preparation
I. Unhealthful lifestyle and personal habits/practices
J. Inherent personal characteristics
K. Health history which may participate/ induce the occurrence of a health
deficit
L. Inappropriate role assumption
M. Lack of immunization/ inadequate immunization status specially of children
N. Family disunity
O. Others

C. HEALTH DEFICITS
- Instances of failure in health maintenance (disease - regardless of whether it
is diagnosed or undiagnosed by medical practitioner, disability, developmental
lag)

D. STRESS POINTS / FORESEABLE CRISIS

- 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.__________

Statement of the Problem:

P = Problem, E = Etiology (Cause), S = Signs/Symptoms

Example:
Diarrhea (undiagnosed) as health deficit related to eating of contaminated &
unclean food as evidenced by:
• Loose watery stool
• 4X bowel movement/day
• Poor skin turgor body weakness,and as verbalized,”symptom kahapon
pa sang aga ako naga lupot”. “kag nagakutoy akon tiyan”.

Data collection for first level assessment includes gathering the five types of
data, namely:

Family structure and Include family composition and demographic data, type
characteristics of family form and structure, decision-making patterns
and communication patterns affecting family
relatedness
Socio-economic and Include occupation, place of work, and income of each
cultural factors working member, educational attainment, ethnic
background, religious affiliation, family traditions and
the relationship of the family to a larger community
Home and Include information on housing and sanitation facilities;
Environmental factors kind of neighborhood and availability of social, health,
communication, and transportation facilities in the
community.
Health assessment of Includes current and past significant health conditions
each member or illness; beliefs and practices conducive to health and
illness; nutritional and developmental status; physical
assessment findings and significant results of
laboratory/ diagnostic tests/ screening procedures
Value placed on Include use of promotive - preventive services as
health evidenced by immunization status and use of other
promotions, health healthy lifestyle related services; adequacy of rest/sleep
maintenance and
prevention of disease

Data gathering methods includes:

Observation, physical examination, interview, review of records and laboratory
and diagnostic procedures.

2. SECOND LEVEL ASSESSMENT

- identifies the nature or type of nursing problems the family experiences in the
performance of their health tasks with respect to a certain health condition or
health problem.

FIVE MAIN TYPES OF FAMILY NURSING PROBLEMS

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:
i. Social-stigma, loss of respect of peer/significant others
ii. Economic/cost implications
iii. Physical consequences
iv. 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
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:
i. Social consequences
ii. Economic consequences
iii. Physical consequences
iv. 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. In accessibility of appropriate resources for care, specifically:
i. Physical Inaccessibility
ii. 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:
i. Absence of responsible member
ii. Financial constraints
iii. Limitation of luck/lack of physical resources
g. Significant persons unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which 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 on concerns/interests
j. Prolonged disease or disabilities, which exhaust supportive capacity of family
members.
k. Altered role performance, specify.
i. Role denials or ambivalence
ii. Role strain
iii. Role dissatisfaction
iv. Role conflict
v. Role confusion
vi. Role overload
vii. Others. Specify._________

IV. Inability to provide a home environment conducive to health maintenance

and personal development due to:
a. Inadequate family resources specifically:
i. Financial constraints/limited financial resources
ii. Limited physical resources-e.i. 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 :
i. Physical/psychological consequences
ii. Financial consequences
iii. Social consequences
f. Unavailability of required care/services
g. Inaccessibility of required services due to:
i. Cost constrains
ii. Physical inaccessibility
h. Lack of or inadequate family resources, specifically
i. Manpower resources, e.g. baby sitter
ii. Financial resources, cost of medicines prescribe
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 __________

Second Level of Assessment:

Example:
Inability to provide adequate nursing care due to:
a. Lack of knowledge and skill in treatment of diarrhea as verbalized by
the mother: “Wala ko kabalo kon paano bulngon ang lupot”.

Family health task

In order to achieve wellness among its members and reduce or eliminate
health problems, the standard or norm of the family as a functioning unit
involves the ability to perform the following health tasks:
A. Recognize the presence of a wellness state or health condition or problem
B. Make decisions about taking appropriate health action to maintain wellness
or manage the health problem
C. Provide nursing care to the sick, disabled, dependent or at-risk members
D. Maintain a home environment conducive to health maintenance and
personal development
E. Utilize community resources for health care
Note:
• Utilizing the data gathered from the Initial Data Base (IDB), the nurse goes
though the data analysis. The end-result of the analysis during the first-level
assessment is a conclusion or a statement of a health condition or problem,
classified as a wellness potential, health threat and health deficit or stress
point/ foreseeable crisis.
• The second - level of assessment ends with a definition of family nursing
problems, in terms of how the family handles it.

PLANNING, IMPLEMENTING AND EVALUATING IN FAMILY NURSING PRACTICE

FAMILY NURSING CARE PLAN
Is a blueprint of nursing care designed to systematically enhance the family’s
capability to maintain wellness, manage health problems through explicitly
formulated goals and objectives of care and deliberately chosen set of
interventions, resources, & evaluation criteria, standards, methods/tools.

STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

1. Prioritize Health Conditions or Problems
2. Goal and Objectives of Nursing Care
3. Intervention Plan
4. Evaluation Plan

HEALTH PROBLEM
Process whereby existing and potential health conditions or problem of the
families are determined. They reflect depth of data gathering and analysis on
what health conditions or problems exists.
This is derived from the First Level Assessment of the Typology of Nursing
Problems.
Which categorizes the presence of:
Wellness state
Health deficits
Health threats
Foreseeable crisis or stress points

FAMILY NURSING DIAGNOSIS

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.
This is derived from the Second Level Assessment of the Typology of Nursing
Problems.
This include those that specify or describe the family’s realities, perceptions
about and attitudes related to the assumption or performance of family health
tasks on each health condition or problem identified during the first-level
assessment.
The nurse should learn to prioritize the numerous family nursing problem
considering the available resources of the nurse, the family and the community.
FOUR CRITERIA IN PRIORITIZNG HEALTH CONDITIONS (Maglaya et. al., 2017)
1. NATURE OF THE PROBLEM
- Is the problem a:
a. Wellness condition
b. Health deficit
c. Health threat
d. Foreseeable crisis

2. MODIFIABILITY OF THE CONDITION

- Probability of success in enhancing wellness state, improving the condition,
minimizing, alleviating or totally eradicating the problem through intervention.

- Factors to consider in determining modifiability of the problem:

o Current knowledge, technology and interventions to enhance wellness state
or manage the problem
o Resources of the family-physical, financial and manpower
o Resources of the nurse-knowledge, skill and time
o Resources of the community-facilities and community organization or
support

3. PREVENTIVE POTENTIAL
- Nature and magnitude of future problems that can be minimized or totally
prevented if interventions are done on the problem.

- Factors to consider in determining preventive potential:

o Gravity or severity of the problem – refers to the progress of disease
indicating extent of damage on the client. The more severe of advanced the
problem, the lower is the preventive potential.

o Duration of the problem – refers to the length of time the problem has been
existing. Has a direct relationship to gravity & preventive potential.

O Current Management – refers to the presence and appropriateness of

intervention measures instituted to enhance the wellness state or remedy
the problem. The institution of appropriate intervention increase the
preventive potential.

o Exposure of any vulnerable or high-risk group – Increases the preventive

potential in determining the score for salience. The family’s concerns, felt
needs, or readiness increases the salience.

4. SALIENCE
- Family’s perception & evaluation of the problem in terms of seriousness &
urgency of attention needed or family readiness.

Scale for Ranking Health and Conditions and Problems According to Priorities
Criteria Score Weight
Nature of the Condition
Wellness State 3 1
Health Deficit 3
Health Threat 2
Foreseeable Crisis 1

Modifiability of the Condition

Easily modifiable 2 2
Partially modifiable 1
Not modifiable 0

Preventive Potential
High 3 1
Moderate 2
Low 1
Salience
A condition needing immediate attention 2 1
A condition needing immediate attention 1
Not perceived as a condition needing change 0

SCORING AND PRIORITIZING

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
------------------------ X Weight
Highest Score
3. Sum up the scores for all the criteria.
The highest score is 5, equivalent to the total weight.
4. Rank the overall score of each nursing problem.
5. The nursing problem with the highest score will be the priority while the
problem with the lowest score will be the least priority.

Example
Diarrhea (undiagnosed) as health deficit related to eating of contaminated &
unclean food.

Criteria Score Weight Computation

Nature of the Condition
Wellness State 3 1 3/3 X1 1
Health Deficit
Health Threat
Foreseeable Crisis
Modifiability of the Condition
Easily modifiable 2 2 2/2 X2 2
Partially modifiable
Not modifiable
Preventive Potential
High 3 1 3/3 X1 1
Moderate
Low
Salience
A condition needing immediate attention 2 1 2/2 X1 1
A condition needing immediate attention
Not perceived as a condition needing change

TOTAL 5

GOAL OF CARE
• a broad desired outcome toward which behavior is directed.
• The Cardinal Principle: Goals must be jointly set with the family.
This ensures the family commitment to their realization.
• Goals set by the nurse & family should be realistic or attainable.
• Too high goals & their consequent failure frustrate both the family & the
nurse.

OBJECTIVES OF CARE
• This refers to a more specific / more precise statements of the desired results
or outcome of care.
• The more specific the objective, the easier is the evaluation of their
attainment.
Types of objective:

1. Short term/ Immediate objective

• Formulated for problem which require immediate attention and results
observed is short time period with few nurse family contacts, use of less
resources.

2. Long term/ Ultimate objective

• Require several nurse-family encounters & investment of more resources.
Outcomes sought require time to demonstrate.

3. Medium term/ Intermediate objective

• Those which are not immediately achieved.

Components of an objective (ABCD):

1. Actor / Subject – client, any part of the client or some attributes of the client.
2. Behavior / Verb – action of the client to perform.
3. Conditions / Modifiers - explain the circumstances under which the behavior
is to be performed, (what, where, when, how)
4. Determinant / Criterion of Desired Performance - Level at which the client
will perform the specified behavior.

Example:
Diarrhea (undiagnosed) as health deficit related to eating of contaminated &
unclean food.

Goal
After 1 day of effective health care strategies, Rosario’s diarrhea will be
lessened from 4x bowel movement to twice/day.

Objective
Within 2 hours of health education and nursing care, the family will:
a. Provide adequate nursing care

HEALTH CARE STRATEGIES

This involves selection of appropriate nursing interventions/ health care
strategies based on the formulated goal and objective.

Focus on Interventions to Help the Family Performs Health Tasks

- Help the family recognize the problem
- Guide the family on how to decide on appropriate health actions to take.
- Develop the family’s ability and commitment to provide nursing care to each
member.
- Enhance the capability of the family to provide home environment conducive
to health maintenance and personal development.
- Facilitate the family’s capability to utilize community resources for health care.

Guidelines for Implementing Nursing Activities

- Nursing actions should be based on scientific knowledge, nursing research and
professional standards of care.
- Nurse should understand clearly the orders to be implemented and question
any that are not understood.
- Nursing actions should be adapted to the individual client.
- Nursing actions should always be safe.
- Nursing actions often require teaching, support and comfort.
- Nursing actions should be holistic.
- Nursing actions should respect the dignity of the client and enhance the
client’s self esteem
- Clients should be encouraged to participate actively in implementing the
nursing actions.

Implementation requires the following skills from the nurse:

- Cognitive Skills – problem solving, decision making, critical thinking and
creative thinking.
- Interpersonal or communication skills
- Technical skills – hands on skills such as manipulating equipment, giving
medications and others.

Example:
Diarrhea (undiagnosed) as health deficit related to eating of contaminated &
unclean food.

Health Care Strategies:

a. Teach and demonstrate to the mother how to mix and give ORS as follows:
1 L of clean & potable water mix with 8 level tsps. Sugar and 1 level tsp. salt
a. Give frequent small sips of ORS over 4hr period.
b. Give extra fluid, food-based fluids such as soup, rice water or buko juice
c. Continue breast feeding frequently and longer at each feeding.
EVALUATION
Specifies how the nurse will determine changes in health status, condition and
achievement of outcomes of care specified in the objectives of family nursing
care plan.

Ongoing Evaluation – done while or immediately after implementing an order;

enables nurse to make on-the-spot modifications in an intervention.

Intermittent Evaluation- performed at specific time intervals to show the

extent of progress
towards the goal and enables nurse to correct any deficiencies and modify care
plan; also called PROCESS Evaluation.

Terminal Evaluation – indicates client’s condition at the time of discharge;

includes status of goal
achievement and an evaluation of the client’s self-care abilities with regard to
follow-up care

Example:
Diarrhea (undiagnosed) as health deficit related to eating of contaminated &
unclean food.

Evaluation:
After 1 day of Health teaching and Nursing Care, the goal is partially met as
evidenced by soft formed stool 2x per day and the parents now provides
proper care to Rosario.

Sample Family Care Plan Sample Matrix

Health Problem Goal/Objectives Health Strategies Evaluation
1st level assessment After 1 day of After 1 day of
Diarrhea (undiagnosed) effective health Health teaching
as care strategies, and Nursing Care,
health deficit related to Rosario’s diarrhea the goal is
eating of contaminated will be lessened partially met
& from 4x bowel as evidenced
unclean food as movement to by soft formed
evidenced by: twice/day. stool 2x per day
- Loose watery stool and the parents
- 4X bowel now provides
movement/day proper care to
- Poor skin turgor body Rosario.
weakness,and as
verbalized, ”symptom
kahapon pa sang aga
ako naga lupot”. “kag
nagakutoy akon
tiyan”.

2nd level assessment Within 2 hours of a. Teach and

Inability to provide health education demonstrate to
adequate nursing care and Nursing care, the mother how
due to: the family will: to mix and give
a. Lack of knowledge a. Provide ORS as follows:
and skill in treatment of adequate 1 L of clean &
diarrhea as verbalized nursing care potable water mix
by the mother: “Wala ko with 8 level
kabalo kon paano tsps. Sugar and 1
bulngon ang lupot”. level tsp. Salt

a. Give frequent
small sips of ORS
over 4hr period.
b. give extra fluid,
food-based fluids
such as soup, rice
water or buko
juice
c. continue breast
feeding
frequently and
longer at each
feeding.