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Nursing Assessment in Family
Health Practice
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Family Health Nursing Practice
Involves a set of actions 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
well being among its members.
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Family Nurse Practitioner
Meets the health care needs of the family
by providing health assessments, direct
care, and guidance, teaching orcounseling as appropriate, particularly
around family self care.
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Levels of Nursing assessment
First level Assessment Data gathering and analysis on what health
conditions or problems exist and why it exists
Second level Assessment Explanations about the familys problems
related to maintaining wellness and/or provide
a home environment conducive to health
maintenance and personal development.
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Primary Assessment
Is a process where existing and potential healthconditions or problems of the family aredetermined.
Four Categories: Wellness state,
Health threats,
Health deficits,
Stress points or foreseeable crisis situations
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Wellness State Wellness is generally used to mean a healthy balance of the
mind, body and spirit that results in an overall feeling ofwell-being.
Wellness is a view of health that emphasizes the state of the
entire being and its ongoing development.
Determinants of wellness: better understanding of concepts like destiny,
health practices,
spirituality,
family,
environment,
work, money and security,
health services,
social support and leisure.
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Health Threats
Conditions that are conducive to disease andaccident, or may result to failure to maintain
wellness or realize health potential
Risk factors of specific disease
Family size beyond family resources
Accident hazards
Unhealthy nutritional/eating habits or feeding techniques practices
Stress-provoking factors
Poor environmental condition/sanitation Unsanitary food handling & preparation
Lack/Inadequate immunization
Family disunity
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Health Deficits
Instances of failure in health maintenance
Illness states
Failure to thrive/develop
Disability
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Stress Points/Foreseeable Crisis
Anticipated periods of unusual demand onthe individual or family in terms of
adjustment, family or resources Marriage
Pregnancy
Parenthood
Additional member\
Divorce or separation
Loss of jobs
Hospitalizations
Death of a member
Adolescence
School entrance
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Second-Level Assessment
The nature or type of nursing problems
that the family encounters in performing
the health tasks with respect to a givenhealth condition or problem, and the
etiology or barriers to the familys
assumption of these tasks.
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1. Determine if the family recognizes the existence of the condition or
problem. If the family does not recognize the presence of the conditionor problem, explore the reason why.
2. 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
condition or problem, determine if the solution is effective.
3. Determine if the family encounter other problems in implementing the
interventions for the wellness state/potential, health threat, health
deficit or crisis.4. Determine how all the other members are affected by the wellness
state/potential, health threat, health deficit or stress point.
Second-Level Assessment
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STEPS IN FAMILY NURSING
ASSESSMENT
Data Collection
Data Analysis/ Interpretation
Diagnosis/Problem definition
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Types of data which will generate the
categories of health problem
1 . Family structure, characteristics and
dynamics;
2. Socio-economic and cultural characteristics;
3. Home and environment;
4. Health status of each member; and
5. Values and practices on health
promotion/maintenance and diseaseprevention
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Family Structure, Characteristic & Dynamics
1. Members of the family and relationship to the head
2. Demographic data-age, sex, civil status, position
3. Place of residence of each member
4. Type of family structure e.g. nuclear/extended
5. Dominant family member in decision making
6. General family relationship/dynamics
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Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, work place & income of working memberb. Adequacy to meet basic necessities
c. Who makes decisions about money and how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant othersrole they play in familys life
5. Relationship of family to larger community
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Home and Environment
1. Housinga. Adequacy of living space / Sleeping arrangement
b. Presence of breeding sites of vectors & diseases
c. Presence of accident hazards
d. Food storage and cooking facilities
e. Water supply source , ownership, potability
f. Toilet facility type, ownership, sanitary condition
g. Garbage disposal type, sanitary condition
h. Drainage system type, sanitary condition
2. Kind of neighborhood e.g. congested, slum, etc
3. Social and health facilities available
4. Communication and transportation facilities available
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Health Status of Each Family Member
1. Medical and nursing history current or past illnesses
2. Nutritional assessment
a. Anthropometric data weight, height, body mass index
b. Dietary history specifying quality/quantity of food intake per day
c. Eating / Feeding habits and practices
3. Developmental assessment of infants, toddlers andpreschoolers (MMDST)
4. Risk factor assessment predisposing and contributing factors
5. Physical assessment indicating presence of illness state/s
6. Results of laboratory/diagnostic and other screeningprocedures
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Values, Habits, Practices on Health
1. Immunization status of family members
2. Healthy lifestyle practices
3. Adequacy of:a. Rest and sleep
b. Exercise and activity
c. Use of protective measures
d. Relaxation & other stress managementactivities
4. Use of promotive-preventive health services
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Data Analysis
1.Sort data
2. Cluster/Group Related Data
3. Distinguish relevant from Irrelevant Data
4. Identify Patterns
5. Compare patterns with Norms or Standards
6. Interpret Results
7. Make Inferences/Draw Conclusions
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Classification of Standards/Norms
1.Normal health of individual members
2. Home and environmental conditionsconducive to health development, and
3.Family characteristics, dynamics or level
of functioning conducive to familydevelopment
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Standards/Norms of a Functioning
Family Unit
1. Recognize the presence of a wellness state or healthcondition or problem
2. Make decisions about taking appropriate healthaction to maintain wellness or manage the healthproblem
3. Provide nursing care to the sick, disabled,dependent or at-risk members
4. Maintain a home environment conducive to health
maintenance and personal development5. Utilize community resources for health care
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Family Characteristics
Constitutes the clients ability as a system to
maintain its integrity and achieve its purpose
through a dynamic interchange among its
members while responding totheexternalmulti-environments along a time continuum.
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Characteristics of healthy family
functioning:
Flexible role patterns
Responsiveness to needs of individual members
Dynamic problem mechanism
Ability to accept help
Open communication patterns
Experience of trust and respect in a warm and caringatmosphere
Capacity to maintain and create constructiverelationships with the broader neighborhood andcommunity.
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Nursing Diagnoses: Family Nursing
Problems
A wellness state or health condition becomes
a nursing problem when it is stated as: the
familys failure to perform adequately
specific health tasks to enhance the
wellness state or manage the healthproblems.
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Typology Of Nursing Problems In
Family Nursing PracticeFIRST-LEVEL ASSESSMENT
1. 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)
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Wellness Potential
Is a nursing judgment on wellness state or
condition based on clients performance,
current competencies or clinical data but no
explicit expression of client desire.
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Readiness for Enhanced Wellness
A nursing judgment on wellness state or
condition based on clients current
competencies or performance, clinical data
and explicit expression of desire to achieve ahigher level of state or function
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A. Potential for Enhanced Capability
for:
1. Healthy Lifestyle
2. Health Maintenance/Health Management
3. Parenting4. Breastfeeding
5. Spiritual Well-being
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B. Readiness for Enhanced Capability
For:
1. Healthy Lifestyle
2. Health maintenance/Health management
3. Parenting4. Breastfeeding
5. Spiritual Well-Being
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II. Presence of Health threats
A conditions that are conducive to disease and
accident, or may result to failure to maintain
wellness or realize health potential.
Examples:
a. Presence of risk factors of specific diseases
b. Threat of cross infection
c. Family size beyond what family resourcesd. Accident hazards
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E. Faulty/Unhealthful nutritional/eating
habits or Feeding techniques practicesF. Stress-provoking factors
G. Poor home/Environmental
Condition/SanitationH. Unsanitary food handling and
preparation
I. Unhealthful lifestyle and personalhabits/Practices
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J. Inherent personal characteristics
k. Health history
L. Inappropriate role assumption
M. Lack of ImmunizationN. Family Disunity
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III. Presence of health Deficits
Instances of failure in health
maintenance.
Examples:
Illness states
Failure to thrive/develop according tonormal rate
Disability
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IV. Presence of Stress
Points/Foreseeable Crisis
Anticipated periods of unusual demand on theindividual or family in terms of adjustment
resources.
Ex.
a. Marriage
b. Pregnancyc. Parenthood
d. Additional member
e. abortion
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f. Entrance at school
g. Adolescenceh. Divorce or separation
I. Menopause
j. Loss of jobk. Hospitalization of a family member
l. Death of a member
m. Illegitimacy
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Second-Level Assessment
I. Inability to recognize the presence of thecondition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a resultof fear of consequences of diagnosis of problem,
1. Social stigma, Loss of respect of peer
2. economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
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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. Feeling of confusion, helplessness and resignation brought about by
perceived magnitude/severity of the situation
C. Lack of/Inadequate knowledge/insight as to alternative courses of action
open to them
D. Inability to decide which action to take from among list of alternativesE. Conflicting opinions among family members regarding action to take
F. Lack of/Inadequate knowledge of community resources of care
G. Fear of consequences of action
H. Negative attitude toward the health condition
I. Inaccessibility of appropriate resources for care
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III. Inability to provide adequate nursing
care to the sick, disabled, dependent or
vulnerable/ at risk member of the familydue to:
A. lack of inadequate knowledge about the
disease/ health condition
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B. Lack of knowledge about child development
C. Lack of knowledge of the nature and extent ofnursing care needed.
D. Lack of facilities
E. Altered role performance
Role denial
Role strain
Role dissatisfaction
Role conflict
Role confusion
Role overload
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III. Inability to provide a home environment conducive to healthmaintenance and personal development due to :
A. Lack of knowledge of importance of hygiene and sanitation
B. Lack of supportive relationship among family members
C. Inadequate family resources
D. Lack of/Inadequate knowledge of importance of hygiene andsanitation
E. Lack of skill in carrying out measures to improve home envtF. Ineffective communication patterns within the family
G. Lack of supportive relationship among family members
H. Negative attitude/philosophy in life which is not conducive tohealth maintenance and personal development.
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IV. Failure to utilize community resources for healthcare due to:
A. Lack of/Inadequate knowledge of community resources forhealth care
B. Lack of trust/confidence in the agency/personnel
C. Failure to perceive the benefits of health care/services
D. Previous unpleasant experience with health worker E. Unavailability of required care/service
F. Inaccessibility of required care/service due to cost constraints orphysical inaccessibility
G. Lack of adequate family resources
H. Negative attitude/philosophy in life which hinders effectiveutilization of community resources for health care
I. Feeling of alienation to/lack of support from the community
-Recognize Need to use data based on evidence-Ensure accuracy and reliability of data
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Ensure accuracy and reliability of data-Check for inconsistencies-Complete missing informationDATA COLLECTION
First-level-Data onStatus condition of:Family/householdmembers
Home and Environment
Second Level- DataFamilys assumption
Of health condition/Problem identified
Methods/Sources:1st level assessmentHealth Status of theFamilyHealth assessment
LaboratoryRecords/reports
Home and EnvironmentObservation/OcularsurveyInterviewDx TestRecords/reportsSecond Level
Assessment:In-Depth Interview onrealitiesPerception about andattitudesTowards performance oftaskObserve: Relate verbalwithnonverbal
DATAANALYSIS
-Sort data
-Cluster/ grouprelated data
-Distinguishrelevant fromirrelevant data
-Identify patterns
(e.g. function,behaviorlifestyle)
-Comparepatterns withnorms orstandards
-Interpret results
-Make inferences/drawconclusions
-First- level assessment: Define the health
Conditions/ problems (categorized as:
Wellness states, health deficits, health
Threats, foreseeable crises or stress points)
Second- level assessment: Define the family nursing
problems/
Diagnosis (table 3) as statements of:
Familys inability to perform Health
Tasks on each
Health Condition/
Problem specifying the barriers to
performance
or reasons for non- performance of
Family Health task
Continuous Data Validation/ Update for Adequacy ofEvidence to Support Diagnosis