A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST LEVEL ASSESSMENT I.

. Presence of Wellness Condi ion 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 !""#$. %ellness potential is a nursing judgment on wellness state or condition based on client&s performance current competencies or clinical data but no e'plicit e'pression of client desire. (eadiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client&s current competencies or performance clinical data and e'plicit e'pression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance. )'amples of these are the following* A. Potential for )nhanced +apability for* #. ,ealthy lifestyle e.g. nutrition-diet e'ercise-activity !. ,ealth maintenance-health management .. Parenting /. 0reastfeeding 1. 2piritual well3being process of a client&s developing-unfolding of mystery through harmonious intercorrectedness that comes from inner strength-sacred source-4od (NANDA !""#$ 5. 6thers specify* 77777777777777777777 0. (eadiness for )nhanced +apability for* #. ,ealthy lifestyle !. ,ealth maintenance-health management .. Parenting /. 0reastfeeding 1. 2piritual %ell3being 5. 6thers specify* 77777777777777777777 II. Presence of !e"l # T#re" s conditions that are conducive to disease and accident or may result to failure to maintain wellness or reali8e health potential. )'amples of these are the following* A. Presence of ris9 factors of specific diseases (e.g. lifestyle diseases metabolic syndrome$ 0. :hreat of cross infection from a communicable disease case +. ;amily si8e beyond what family resources can ade<uately provide D. Accident ha8ards specify* #. bro9en stairs !. pointed-sharp objects poisons and medicines improperly 9ept .. fire ha8ards /. fall ha8ards 1. others (specify$* 777777777777777777777

). ;aulty-unhealthful nutritional-eating habits or feeding techni<ues-practices. 2pecify* #. inade<uate food inta9e both in <uality and <uantity !. e'cessive inta9e of certain nutrients .. faulty eating habits /. ineffective breastfeeding 1. faulty feeding techni<ues ;. 2tress3provo9ing factors specify* #. strained marital relationship !. strained parent3sibling relationship .. interpersonal conflicts between family members /. care3giving burden 4. Poor home-environmental conditions-sanitation specify* #. inade<uate living space !. lac9 of food storage facilities .. polluted water supply /. presence of breeding or resting sites of vectors of diseases (e.g. mos<uitoes flies roaches rodents etc.$ 1. improper garbage-refuse disposal 5. unsanitary waste disposal =. improper drainage system >. poor lighting and ventilation ?. noise pollution #". air pollution ,. @nsanitary food handling and preparation I. @nhealthful lifestyle and personal habits-practices specify* #. alcohol drin9ing !. cigarette-tobacco smo9ing .. wal9ing barefooted or inade<uate footwear /. eating raw meat or fish 1. poor personal hygiene 5. self3medication-substance abuse =. se'ual promiscuity >. engaging in dangerous sports ?. inade<uate rest or sleep #". lac9 of-inade<uate e'ercise-physical activity ##. lac9 of-inade<uate rela'ation activities #!. non3use of self3protection measures (e.g. non3use of bed nets in malaria and filariasis endemic areas$ A. Inherent personal characteristics e.g. poor impulse control B. ,ealth history which may participate-induce the occurrence of a health deficit e.g. previous history of difficult labor C. Inappropriate role assumption e.g. child assuming mother&s role father not assuming his role D. Cac9 of immuni8ation-inade<uate immuni8ation status specially of children

N. ;amily disunity e.g. #. self3oriented behavior of member(s$ !. unresolved conflict of member(s$ .. intolerable disagreement 6. 6thers specify* 777777777777777777 III. Presence of !e"l # $efici s instance of failure in health maintenance. )'amples include* A. Illness states regardless of whether it is diagnosed or undiagnosed by medical practitioner 0. ;ailure to thrive-develop according to normal rate +. Disability whether congenital or arising from illnessE transient-temporary (e.g. aphasia or temporary paralysis after a +FA$ or permanent (e.g. leg amputation secondary to diabetes blindness from measles lameness from polio$ Presence of 2tress Points-;oreseeable +risis 2ituations anticipated periods of unusual demand on the individual or family in terms of adjustment-family resources. )'amples of these include* Darriage Pregnancy labor puerperium Parenthood Additional member e.g. newborn lodger Abortion )ntrance at school Adolescence Divorce or separation Denopause Coss of job ,ospitali8ation of a family member Death of a member (esettlement in a community Illegitimacy 6thers specify 777777777777777777

IF. A. 0. +. D. ). ;. 4. ,. I. A. B. C. D. N. 6.

SECON$%LEVEL ASSESSMENT I. Inability to recogni8e the presence of the condition or problem due to* A. Cac9 of or inade<uate 9nowledge 0. Denial about its e'istence or severity as a result of fear or conse<uences of diagnosis of problem specifically* #. social3stigma loss of respect of peer-significant others !. economic-cost implications .. physical conse<uences /. emotional-psychological issues-concerns +. Attitude-philosophy in life which hinders recognition-acceptance of a problem D. 6thers specify 7777777777777777777 II. Inability to ma9e decisions with respect to ta9ing appropriate health action due to* A. ;ailure to comprehend the nature-magnitude of the problem-condition 0. Cow salience of the problem-condition +. ;eeling of confusion helplessness and-or resignation brought about by perceived magnitude-severity of the situation or problem i.e. failure to brea9down problems into manageable units of attac9 D. Cac9 of-inade<uate 9nowledge-insight as to alternative courses of action open to them ). Inability to decide which action to ta9e from among a list of alternatives ;. +onflicting opinions among family members-significant others regarding action to ta9e 4. Cac9 of-inade<uate 9nowledge of community resources for care ,. ;ear of conse<uences of action specifically* #. social conse<uences !. economic conse<uences .. physical conse<uences /. emotional-psychological conse<uences I. Negative attitude towards the health condition or problem 0y negative attitude is meant one that interferes with rational decision ma9ing A. Inaccessibility of appropriate resources for care specifically* #. physical inaccessibility !. cost constraints or economic-financial inaccessibility B. Cac9 of trust-confidence in the health personnel-agency C. Disconceptions or erroneous information about proposed course(s$ of action D. 6thers specify 77777777777777777777 III. Inability to provide ade<uate nursing care to the sic9 disabled dependent or vulnerable-at3 ris9 member of the family due to* A. Cac9 of-inade<uate 9nowledge about the disease-health condition (nature severity complications prognosis and management$E 0. Cac9 of-inade<uate 9nowledge about child development and care +. Cac9 of-inade<uate 9nowledge of the nature and e'tent of nursing care needed D. Cac9 of necessary facilities e<uipment and supplies for care

). Cac9 of inade<uate 9nowledge and s9ill in carrying out the necessary interventions treatment-procedure-care (e.g. comple' therapeutic regimen or healthy lifestyle program$ ;. Inade<uate family resources for care specifically* #. absence of responsible member !. financial constraints .. limitations-lac9 of physical resources e.g. isolation room 4. 2ignificant person&s une'pressed feelings (e.g. hostility-anger guilt fear-an'iety despair rejection$ which disable his-her capacities to provide care. ,. Philosophy in life which negates-hinder caring for the sic9 disabled dependent vulnerable-at3ris9 member I. Dember&s preoccupation with own concerns-interests A. Prolonged disease or disability progression which e'hausts supportive capacity of family members B. Altered role performance specify* #. role denial or ambivalence !. role strain .. role dissatisfaction /. role conflict 1. role confusion 5. role overload C. 6thers specify 777777777777777777 IF. Inability to provide a home environment conducive to health maintenance and personal development due to* A. Inade<uate family resources specifically* #. financial constraints-limited financial resources !. limited physical resources e.g. lac9 of space to construct facility 0. ;ailure to see benefits (specifically long term ones$ of investment in home environment improvement +. Cac9 of-inade<uate 9nowledge of importance of hygiene and sanitation D. Cac9 of-inade<uate 9nowledge of preventive measures ). Cac9 of s9ill in carrying out measures to improve home environment ;. Ineffective communication patterns within the family 4. Cac9 of supportive relationship among family members ,. Negative attitude-philosophy in life which is not conducive to health maintenance and personal development I. Cac9 of-inade<uate 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$ A. 6thers specify 7777777777777777777777 F. ;ailure to utili8e community resources for health care due to* A. Cac9 of-inade<uate 9nowledge of community resources for health care 0. ;ailure to perceive the benefits of health care-services

+. Cac9 of trust-confidence in the agency-personnel D. Previous unpleasant e'perience with health wor9er ). ;ear of conse<uences of action (preventive diagnostic therapeutic rehabilitative$ specifically* #. physical-psychological conse<uences !. financial conse<uences .. social conse<uences e.g. loss of esteem of peer-significant others ;. @navailability of re<uired care-service 4. Inaccessibility of re<uired care-service due to* #. cost constraints !. physical inaccessibility i.e. location of facility ,. Cac9 of or inade<uate family resources specifically* #. manpower resources e.g. baby sitter !. financial resources e.g. cost of medicine prescribed I. ;eeling of alienation to-lac9 of support from the community e.g. stigma due to mental illness AID2 etc. A. Negative attitude-philosophy in life which hinders effective-ma'imum utili8ation of community resources for health care B. 6thers specify 7777777777777777

INITIAL $ATA BASE FOR FAMILY NURSING PRACTICE A. ;amily 2tructure +haracteristics and Dynamics #. Dembers of the household and relationship to the head of the family !. Demographic data age se' civil status position in the family .. Place of residence of each member whether living with the family or elsewhere /. :ype of family structure e.g. matriarchal or patriarchal nuclear or e'tended 1. Dominant family members in terms of decision3ma9ing especially in matters of health care 5. 4eneral family relationship-dynamics presence of any obvious-readily observable conflict between membersE characteristic communication-interaction patterns among members 0. 2ocio3economic and +ultural +haracteristics #. Income and e'penses a. 6ccupation place of wor9 and income of each wor9ing member b. Ade<uacy to meet basic necessities (food clothing shelter$ c. %ho ma9es decisions about money and how it is spent !. )ducational attainment of each member .. )thnic bac9ground and religious affiliation /. 2ignificant others role(s$ they play in family&s life 1. (elationship of the family to larger community Nature and e'tent of participation of the family in community activities +. ,ome and environment #. ,ousing a. Ade<uacy of living space b. 2leeping arrangement c. Presence of breeding or resting sites of vectors of diseases (e.g. mos<uitoes roaches flies rodents etc.$ d. Presence of accident ha8ards e. ;ood storage and coo9ing facilities f. %ater supply source ownership potability g. :oilet facility type ownership sanitary condition h. 4arbage-refuse disposal type sanitary condition i. Drainage system type sanitary condition !. Bind of neighborhood e.g. congested slum etc. .. 2ocial and health facilities available /. communication and transportation facilities available D. ,ealth 2tatus of each ;amily Dember #. Dedical and nursing history indicating current or past significant illnesses or beliefs and practices conducive to health and illness !. Nutritional assessment (specially for vulnerable or at3ris9 members$ a. Anthropometric data* Deasures of nutritional status of children weight height mid3upper arm circumferenceE ris9 assessment measures for obesity* 0ody Dass

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1. 5.

Inde' (0DI G wt. in 9gs. divided by ht. in meters !$ waist circumference in cm. divided by hip circumference in cm. +entral obesity* %,( e<ual to or greater than #." cm. in men and ".>1 in women$. b. Dietary history specifying <uality and <uantity of food-nutrient inta9e per day c. )ating-feeding habits-practices Developmental assessment of infants toddlers and preschoolers e.g. Detro Danila Developmental 2creening :est (DDD2:$. (is9 factor assessment indicating presence of major and contributing modifiable ris9 factors for specific lifestyle diseases e.g. hypertension physical inactivity sedentary lifestyle cigarette-tobacco smo9ing elevated blood lipids-cholesterol obesity diabetes mellitus inade<uate fiber inta9e stress alcohol drin9ing and other substance abuse Physical assessment indicating presence of illness state-s (diagnosed or undiagnosed by medical practitioners$ (esults of laboratory-diagnostic and other screening procedures supportive of assessment findings

). Falues ,abits Practices on ,ealth Promotion Daintenance and Disease Prevention. )'amples include* #. Immuni8ation status of family members !. ,ealthy lifestyle practices. 2pecify 777777777777777777777 .. Ade<uacy of* a. (est and sleep b. )'ercise-activities c. @se of protective measures e.g. ade<uate footwear in parasite3infested areas use of bed nets and protective clothing in malaria and filariasis endemic areas d. (ela'ation and other stress management activities /. @se of promotive3preventive health services