TYPOLOGY OF NURSING PROBLEMS IN FAMILY HEALTH CARE

FIRST LEVEL ASSESSMENT (Presence of Health Threats, Deficits, & Stress Points)

II. Presence of Health Threats —conditions that are conducive to disease, accident or failure to realize one's health
potential.

A. Family history of hereditary condition/disease, e.g., diabetes

B. Threat of cross Infection from a communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards-e.g.
1. Broken stairs 3. Fire hazards
2. pointed/sharp objects, poisons and medicines 4. Fall hazards
improperly kept
E. Faulty/unhealthful nutritional/eating habits
1. Inadequate food intake both in quantity and quality 3. Faulty eating habits
2. Excessive Intake of certain nutrients
F. Stress provoking factors
1. Strained marital relationship 3. Interpersonal conflicts between family members
2. Strained parent-sibling relationship
G. Poor environmental sanitation
1. Inadequate living space 6. Improper garbage/refuse disposal
2. Inadequate personal belongings/utensils 7. Unsanitary waste disposal
3. Lack of food storage facilities 8. Improper drainage system
4. Polluted water supply 9. Poor lighting and ventilation
5. Presence of breeding or resting sites of insects, 10. Noise pollution
rodents or other vectors 11. Air pollution
H. Unsanitary food handling and preparation
I. Unhealthful lifestyle and personal habits/practices
1. Frequent drinking of alcohol 7. Use of dangerous drugs/narcotics
2. Excessive smoking 8. Sexual promiscuity
3. Walking barefoot 9. Engaging in dangerous sports
4. Eating raw meat/fish 10. Inadequate rest/sleep
5. Poor personal hygiene 11. Lack of/inadequate exercise
6. Self-medication 12. Lack of/inadequate relaxation activities
J. Inherent personal characteristics --e.g., short temper
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
immunization/inadequate Immunization status specially of children
N. Family disunity —e.g.
1. self-oriented behavior of member(s) 3. Intolerable disagreements
2. Unresolved conflicts of member(s)
II. Presence of Health Deficits - Instances of failure in health maintenance.

A. Illness states, regardless of whether it is diagnosed C. Disability- whether congenital or arising from Illness;
or undiagnosed by medical practitioner transient/temporary or permanent
B. Failure to thrive/develop according to normal rate

III. Presence of Stress Points/Foreseeable Crisis Situations - anticipated periods of unusual demand on the individual or
family in terms of adjustment/family resources.

A. Marriage H. Divorce or Separation

B. Pregnancy, labor, puerperium I. Menopause
C. Parenthood J. Loss of Job
D. Additional member - e.g., newborn, lodger K. Hospitalization of a family member
E. Abortion L. Death of a member
F. Entrance at School M. Resettlement in a new community
G. Adolescence N. Illegitimacy

SECOND LEVEL ASSESSMENT

I. Inability to recognize the presence of a problem due to:

A. Lack of or inadequate knowledge

B. rear of consequences of diagnosis of problem specifically:
1. Social stigma, toss of respect of peer/significant 2. economic/cost implications
others 3. Physical/psychological effects
C. Attitude/philosophy in life which hinders recognition/acceptance of a problem

II. Inability to make decisions with respect to taking appropriate health action due to:

A. Failure to comprehend the nature, magnitude/scope of the problem

B. Low salience of the problem
C. Feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/gravity of the
problem, i.e., failure to break down problems into manageable units of attack.
D. Lack of or 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/or inadequate knowledge of community resources for care
H. Fear of consequence of action, specifically:
1. Social consequences 3. physical/psychological effects/consequences
2. Economic consequences
I. Negative attitude towards the health problem — by negative attitude is meant one that Interferes with rational
decision making.
J. Inaccessibility of appropriate resources for care, specifically:
1. Physical inaccessibility, 2. cost 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
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 or inadequate knowledge about the disease/health condition

B. Lack of or inadequate knowledge of child development and care
C. Lack of or 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 knowledge and skill in carrying out the necessary treatment/procedure/care F. Inadequate family resources
for care, specifically:
1. Absence of responsible member 3. limitations/lack of physical resources-e.g., isolation
2. Financial constraints room
G. Negative attitude towards the sick, disabled, dependent, and vulnerable/at - risk member
H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at-risk member
I. Members preoccupation with own concerns/interests

IV. Inability to provide a home environment which is 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 of investments in home environment improvement
C. Lack of or inadequate knowledge of importance of hygiene and sanitation
D. Lack of or 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. tack of supportive relationship among family members
H. Negative attitude/philosophy in life which is not conducive to health maintenance and personal development

V. Failure to utilize community resources for health care due to:

A. Lack of or 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
1. Physical/psychological consequences 3. Social consequences — e.g., loss esteem of peer
2. Financial consequences
F. Unavailability of required care/service G. Inaccessibility of required care/service due to:
1. Cost constraints 2. Physical Inaccessibility (location of facility)
H. lack of or inadequate family resources, specifically:
1. Manpower resources (baby sitter) 2. Financial resources (cost of medicine required)

Methods of Data Gathering

I. Health Assessment of Each Family Member

• Health Assessment - an evaluation of the health status of an individual by performing a physical examination after
obtaining a health history.
Physical Examination — a head to toe examination of each body systems where vital signs other objective
measurements are taken.

II. Observation
To observe is to gather data by using the senses. Observation is a conscious, deliberate skill that is developed through
effort and with organized approach.
Observation has 2 aspects:
A. noticing a data B. selecting, organizing, and interpreting the data

III. Interview is the first and really the most important part of data collection.
 It collects subjective data -what the person says about himself/herself.
 A second type of interview is collecting by personally asking significant family members or relative questions
regarding health, family expenses and home environment to generate data on what health problems exist in the
family.
There are 2 approaches to interviewing:
• Directive- highly structured and elicits specific information.
• Non-directive or Rapport Building Interview - nurse allows the client to control the purpose, subject matter and pacing.

IV. Review of Records/Reports and Laboratory Result

• Record Review - the nurse may gather information through reviewing existing records and reports pertinent
information to the client.
 Laboratory Results - another method of data collection Is through performing laboratory tests, diagnostic
procedures or another tests of Integrity and functions carried out by the nurse himself/herself and/or other
health workers.

V. Assessment of Home and Environment

• External variables affecting the health and level of wellness of the individuals include the physical environment,
the family, and the home.
• Where a person lives and the condition of that area determines how they live, what they eat, the disease agents
they are exposed to, their state of health, and their ability to adapt.
• The physical environment in which a person works or lives can Increase the likelihood that certain illnesses will
occur. Geographic location determines climate, and climate effects.

VI. Tools used In Fruity Assessment:

• Genogram – is a pictorial display of a person's family relationships and medical history.

• Ecomap – is a graphical representation that shows all of the systems at play in an individual's life. It is used to assess
family members' interaction with system outside the family.

• Initial Data Base - contains

A. Family Structure, Characteristics and Dynamics D. Health Status of each family member
B. Socio - Economic and Cultural Characteristics E. Values and Practices on Health Promotion/Maintenance
C. Home and Environment and disease prevention

• Family Assessment Guide (Family structure)

Developing the Nursing Care Plan

Family Nursing Care Plan - is the blueprint of the care that the nurse designs to systematically minimize or eliminate the
identified health and family nursing problems through explicit formulated outcomes of care (goal and objectives).

1. Prioritizing Problem - devised a tool called ''scale for ranking health conditions"
Problems According to priorities: The 4 Criteria are:
• 1. Nature of the Condition or Problem Presented • 3. Preventable Potential
• 2. Modifiability of the Condition or Problem • 4. Salience
Presented
2. Defining/Setting Goals/Objectives Categories of Objectives:
• 1. Short Term/Immediate objective • 3. Long term objective
• 2. Medium — Term/intermediate objective. E.g.
medical check up

Nursing goal
• The family will manage those threats and diseases
• A Cardinal principle in goal setting states that goals must be set jointly with the family.
• Goals set by the Nurse and the Family should be realistic and attainable.
• They should therefore be set at reasonable levels.

3. Specifying the Intervention Plan

1. It is the formulation of the intervention plan.
2. This involves the selection of appropriate nursing intervention. The nurse decides the appropriate actions among a set
of alternatives. This includes home visits, telephone call, group approach and use of mails.

4. Developing the Evaluation Plan - The evaluation plan specifies how the nurse determines the changes in health
status, condition or situation and achievements of the outcomes of care.

Steps in Developing FNCP

Prioritize the Health

Conditons and Problrms

Develop the Define Goals and

Evaluation Plan Objectives of Care

Develop the Intervention

Plan
CATEGORIES OF INTERVENTIONS IN FAMILY NURSING PRACTICE INCLUDE:
• The nurse encounters the realities in FNPractice which can motivate her to try out creative Innovations or overwhelm
her to frustration or inaction.
1. Human Becoming: Methods/ Processes
 Phenomenological Experience- A nurse practitioner works with clients; she experiences varying degrees of
demands on her resources. A dynamic attitude on personal and professional development is, therefore,
necessary if the has to face up to the challenges of nsg. Practice.
 Expert Caring - does not happen overnight to a nurse.

2 Major Methods and Possibilities:

1) Performance-focused Learning through Competency-based Teaching
2) Maximizing caring possibilities for Personal and Professional Devt.

2. Competency- Based Teaching

• - Competencies include the cognitive (knowledge), psychomotor (skills), and attitudinal or affective (emotions,
feelings, values).
3) Motivating support for behavior change/lifestyle modification
• The real essence of Nursing is Caring.
• Philosophy and Commitment are the main ingredients of effective nsg. Practice.
• Working with the family can be difficult if its cooperation in carrying health measures cannot be elicited.

ROSENSTOCK'S 3 Principles of Motivation:

1. Preventive or therapeutic behavior relative to a given health problem in the individual. Is determined by the extent to
which he sees the problem as having both serious consequences and a high probability of occurrence in his case and the
extent to which he believes that some course of action open to him will be effective in reducing the threat.
2. Behavior emerges out of frequent conflict among motives and among courses of actions.
3. Health-related motives may not always give rise to health-related behavior and conversely, health-related behavior
may not always be determined by health-related motives.

CATEGORIES OF HEALTH CARE STRATEGIES AND INTERVENTIONS

 I. Preventive( Preventive and Primary Health Care Services)
 Primary care has been defined by the Institute of Medicine(1994) as the" provision of integrated, accessible
health care services by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with clients, and practicing in the context of family and community."
 Preventive Measure- preventive nsg. Actions promote health and prevent illness to avoid the need for acute or
rehabilitative healthcare. Prevention includes assessment and promotion of the client's health potential,
application of prescribed measure (eg.immunization), health teaching and Identification of risk factors for illness
and/or trauma.
 II. Curative - having a tendency to heal or cure related in curing disease and restoring health.
 III. Rehabilitative
• Rehabilitation is a process of restoring ill or injured people to optimum and functional level of wellness. Rehabilitation/
Rehabilitative care emphasizes the importance of assisting clients to function adequately in the physical, mental, social,
economic, and vocational areas of their lives. The goal of rehabilitation is to help people move to their previous level of
health or to the highest level they are capable of, given their current health status.
 IV. Facilitative and Facilitation
  The nurse plans programs within the client's capabilities and considers long- and- short- term goals. The client
needs to learn to take risks. The nurse needs to reinforce successes and help the client recognize failures
realistically and collaborates in client's decisions, provides support and may offer options or information.
 V. Direct
Direct care interventions are treatments performed through intervention with the client. Nurses provide a wide variety
of direct care measures because interaction with the client is involved. The nurse must always be sensitive to the client's
clinical condition, values and beliefs, expectation and cultural view. All direct care measures requires competent and
safe practice.

EVALUATION
• Need for Evaluation
Evaluation is a very important process in nursing practice for it verifies the worth of nursing actions and outcomes. The
evaluation of nursing care given to individuals and families, public health programs and performance of health facilities
and human resources provides very critical information to decision makers at different levels of the health care delivery
machinery.
• Using the results of evaluation, the nurse can modify his/her interventions. A nurse who is more satisfied with
the outcome of his/her performance tends to perform better than the one who Is not satisfied.

Quantitative and Qualitative Data

• Quantitative methods are those which focus on numbers and frequencies rather than on meaning and experience.
These methods provide information which is easy to analyze statistically and fairly reliable e.g. experiments,
questionnaires and psychometric tests.
• Qualitative methods are associated with the scientific and experimental approach and are criticized for not providing
an in depth description e.g. case studies and interviews.

Steps in Evaluation
1. Decide what to evaluate
-the objectives of the NCP, FCP or Program Plan are the bases for evaluation.
-utilizing SMART
2. Design the evaluation plan -done by specifying the data collection methods and tools.