Aquino, MLR / CHN1

1 Nursing Assessment
in
Family Nursing Practice

2 Definition and Concepts

In the family health nursing process, nursing assessment 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.
3

Nursing assessment includes:

Data collection
Data analysis or interpretation
Problem definition or nursing diagnosis

4 Two Major Types:

1. First level assessment

 Is a process whereby existing and potential health conditions or problems of the family
are determined
2. Second level assessment
 Defines as the nature or type of nursing problems that the family encounters in
performing the health tasks with respect to given health condition or problem, and the
etiology or barriers to the family’s assumptions of these tasks.

5 First Level Assessment

Reflect the depth of data gathering and analysis on what health conditions or problem
exist.
6 Second Level Assessment
Data include those that specify or describe the family’s realities, perceptions about and
attitudes related to the assumption of performance of family health task on each health
condition or problem identified during the first level assessment.


7 Steps in Family Nursing Assessment

Data Data Health conditions/

Collection Analysis Problems

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Collection Analysis Problems

&
Family Nursing Diagnoses

8 Data Collection
First, identify the types or data needed
Second, specify the methods of data-gathering and the necessary tools to collect such
data
9 Data Collection
1. Family structure, characteristics and dynamic:
 Composition and demographic data
 Relationship to the head of the family
 Type of family, how they interact and communicate
 Decision making patterns


10 Socio-economic and Cultural Characteristics
Occupation
Place of work
Income of each working member
Educational attainment of each member
Ethnic background, religious affiliation
Relationship of the family to the larger community
11 Home and Environment
Information in housing and sanitation facilities
King of neighborhood
Availability of social, health, communication and transportation facilities in the community

12 Health Status of Each Member

Current and past significant illness
Beliefs and practices conducive to health and illness
Nutritional and developmental status
Physical Assessment findings
Significant results of laboratory, diagnostic test, screening procedures

13 Values and Practices on Health Promotion/Maintenance & Disease Prevention

Adequacy of rest and sleep
Exercise
Relaxation activities
Stress management
Other healthy lifestyle activities

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Other healthy lifestyle activities

Immunizations
14 Data Gathering Method & Tools
1. Observation – use of sensory capacities
2. Physical Examination – IPPA
3. Interview – Health history, Significant questions about health, family life experiences etc.
4. Record review
5. Laboratory/ Diagnostic Test
6.
15 Second Level Assessment
Determine if the family recognizes the existence of the condition or problem
If the family does not recognize the presence of the condition or the problem, explore the
reason why.
Ex: what do you think about the condition of your husband?
Ex: What do you think is happening to your daughter?

16 Second Level Assessment

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.
17 Sample interview questions
Ano ang inyong binabalak tungkol dito?
Anong mga pagbabago ang napansin nyo sa kalagayan ni ________?
18 Second Level Assessment
Determine if the family encounters other problems in implementing the interventions for
the wellness state/potential, health threat, health deficit or crisis.
Ex: what were the problems or barriers encountered in…..?
Ex: What do you think are the reasons why there is no improvement in the condition
of…….?
19 Second Level Assessment
Determine how all the other members are affected by the wellness state/potential, health
threat, health deficit or stress point.
Ex: how are the other members affected by……?
Ex: how are the other reacting to….?
20 Data Analysis
1. Sort data
2. Cluster/group related data
3. Distinguish relevant from irrelevant

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3. Distinguish relevant from irrelevant

4. Identify patterns (Ex: function, behavior, Lifestyle)
5. Compare patterns with norms or standard
6. Interpret results
7. Draw conclusions
8.
21 Health Conditions/Problems and Family Nursing Diagnosis
First level assessment: Define the health conditions/ problems.
Categorized as:
Wellness states
Health Deficits
Health threat
Foreseeable crisis
Stress Points
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FIRST LEVEL OF ASSESSMENT



Presence of Health Threat, Health Deficits, and Foreseeable Crisis or Stress Point in the
Family

23 Health Threat
Any condition conducive to disease, accident or failure to realize one’s health potential
24 Health Threat
 Health history of a specific disease
 Threat of cross-infection
 Family size beyond what family resources can adequately provide
 Accident hazards
 Faulty/unhealthful nutritional habits and feeding techniques/practices
 Stress – provoking factors
 Poor home/environmental condition/sanitation

25 Health Threat
 Unsanitary food handling and preparation
 Unhealthful lifestyle and personal habits/practices
 Inherent personal characteristics

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Inherent personal characteristics

 Health history which may precipitate/induce the occurrence of a health deficit
 Inappropriate role assumption
 Lack of immunization/inadequate immunization status specially of children
 Family disunity


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Health Deficits – instances of failure in health maintenance
 Illness states
 Failure to thrive/develop according to normal rate
 Disability
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• Stress Point/Foreseeable Crisis Situation – anticipated periods of unusual demand on the
individual or family in terms of adjustment/family resources
 Marriage
 Pregnancy
 Parenthood
 Additional member
 Abortion
 Entrance at school
 Adolescence
 Loss of job
 Death of family member
 Resettlement in a new community
 Illegitimacy

28 SECOND LEVEL ASSESSMENT

Inability to recognize the presence of a problem

• Lack of/Inadequate knowledge
• Denial about its existence or severity as a result of fear of consequences of diagnosis of
problem
• Attitude/Philosophy in life which hinders recognition/acceptance of a problem

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Inability to make decision with respect to taking appropriate health action
• Failure to comprehend the nature/magnitude of the problem
• Low salience of the condition/problem
• Feeling of confusion, helplessness and/or resignation brought about by perceived
magnitude/severity of the situation or problem

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• Feeling of confusion, helplessness and/or resignation brought about by perceived

magnitude/severity of the situation or problem
• Lack of/Inadequate knowledge/insight as to alternate courses of action to open to them
• Inability to decide which action to take from among a list of alternates
• Conflicting opinions among family members/significant others regarding action to take
• Ignorance of community resources for care
• Fear of consequences of action
• Negative attitudes toward the health problems
• Inaccessibility of appropriate resources for care
• Lack of trust/confidence in the health person or agency
• Misconception or erroneous information about proposed courses of action

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Inability to provide nursing care to the sick, disabled, dependent or vulnerable/at risk
member of the family
• Lack of/Inadequate knowledge about the disease/health condition
• Lack of/Inadequate knowledge about child development and care
• Lack of/Inadequate knowledge of the nature and extent of nursing care needed
• Lack of the necessary facilities, equipment and supplies of care
• Lack of/Inadequate knowledge and skill in carrying out the necessary
intervention/treatment/procedure/care
• Inadequate family resources for care
• Significant person’s unexpressed feelings which disabled his/her capacities to provide
care
• Philosophy in life which negates/hinder caring for the sick, disabled, dependent,
vulnerable,/at-risk member
• Prolonged disease or disability progression which exhausts supportive capacity of family
members
• Altered role performance – role denial, role strain, role conflict, role dissatisfaction, role
conflict, role confusion, role overload

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Inability to provide a home conducive to health maintenance and personal development
• Inadequate family resources
• Failure to see benefits of investment in home environment improvement
• Lack of/Inadequate knowledge of preventive measures
• Lack of skill in carrying out measures to improve home environment
• Lack of supportive relationship among family members
• Negative attitude/Philosophy in life which is not conducive to health maintenance and
personal development
• Lack of/Inadequate competencies in relating to each other’s mutual growth and
maturation


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Failure to utilize community resources for health care
• Lack of/Inadequate knowledge of community resources for health care
• Failure to perceive the benefits of health care/services
• Lack of trust/confidence in agency/personnel
• Previous unpleasant experience with health worker
• Fear of consequences of action
• Unavailability of required care/services
• Inaccessibility of required care/services
• Lack of/Inadequate family resources
• Feeling of alienation to/lack of support from the community
• Negative attitude/Philosophy in life which hinders effective/maximum utilization of
community resources for health care

33 Family Nursing Care Plan

34 Definition
Family 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 explicitly
formulated outcomes of care (goals and objectives) and deliberately chosen set of
interventions, resources and evaluation criteria, methods and tools.

35 Steps in developing FNCP

1. Prioritize condition/s or problems;
2. The goals and objectives of nursing care
3. The plan of intervention
4. The plan of evaluating care
36 Prioritizing Health Problems
 Nature of the problem or condition presented – categorized into wellness state/potential,
health threat, health deficit and foreseeable crisis.

 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 intervention.
37 Prioritizing Health Problems
Preventive potential – refers to the nature and magnitude of the future problems that can
be minimized or totally prevented if intervention is done on the condition or problem
under consideration

Salience – refers to the family’s perception and evaluation of the condition or problem in
terms of seriousness and urgency of attention needed of family rediness.
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Formulation of Goals and Objective

A goal is a general statement of the condition or state to be brought about by specific

courses of action.
Example: After nursing intervention the family will be able to take care of the disabled child
completely.
A cardinal principle in goal setting states that goals must be set jointly with the family.


42 Barriers to joint goal setting between the nurse and the family include the following:
1. Failure on the part of the family to perceive the existence of the problem.
2. The family may realize the existence of a health condition or problem but is too busy at the
moment with other concerns and preoccupations.
3. Sometimes the family perceives the existence of a problem but does not see it as serious
enough to warrant attention.

43 Barriers to joint goal setting between the nurse and the family include the following:
1. The family may perceive the presence of the problem and the need to take action, however,
refuse to face and to do something about the situation. Freeman offers the following
reasons for this kind of behavior:
a) Fear of consequence/s of taking action
b)Respect for tradition
c) Failure to perceive the benefits of action proposed
d)Failure to relate the proposed action to the family’s goals
1. Failure to develop a working relationship.
44 Objectives
Objectives- refer to more specific statements of the desired results or outcomes of care.
They specify the criteria by which the degree of effectiveness of care is to be measured.

Objectives stated as outcomes of care in family health nursing practice specify physical,
psychosocial states or family behavior.

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Objectives stated as outcomes of care in family health nursing practice specify physical,
psychosocial states or family behavior.

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Example: After nursing intervention, the malnourished preschool members of the family
will increase their weights by at least one pound per month.
After nursing intervention, the family will be able to:
1. Feed the mentally retarded child according to prescribed quantity and quality of food.


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2. Teach the mentally retarded child simple skills related to the activities of daily living.
3. Apply measures taught to prevent infection in the mentally retarded member.
The more the specific the objectives, the easier is the evaluation of their attainment
47 Types: Objective
1. Short-term or immediate objectives- are formulated for problem situations which require
immediate attention, and results can be observed in a relatively short period of time.
2. Long-term or ultimate objectives – require several nurse-family encounters and an
investment of more resources.
3. Medium-term or intermediate objectives – are those which are not immediately achieved
and are required to attain the long term ones.
48 Example:
Nursing goal: the family will manage malaria as a disease and threat.
Short-term – sick member/s will take the drugs accurately as to dose, frequency, duration
and drug combination. All members will use self-protection measures at night till early
morning when biting time of malaria is expected.

49 Example:
Medium-term – all members will have medical check up and laboratory confirmation to
diagnose malaria.
Long-term – all members will carry out mosquito vector control measures.

50 Developing the Intervention Plan

This involves selection of appropriate nursing interventions based on the formulated goals
and objectives.

51 Nurse-Family Contact
Home visit
Clinic conference
Visit in the work place
School visit

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School visit
Telephone call
Group approach (ex. Health classes)
Mail/emails

52 Resources:
Supplies
Equipment
Teaching aids/kits
Visual materials
Handouts
Charts
Human resource (other member of the health care team, community leaders, development
leaders)

53 Focus on Interventions to Help the Family Perform the Health Tasks

1. Help the family recognize the problem – examples of nursing interventions to enhance the
family’s ability to recognize its health needs and problems include:
a) Increasing the family’s knowledge on the nature, magnitude and cause of the problem.

54 Focus on Interventions to Help the Family Perform the Health Tasks

b) Helping the family see the implications of the situation, or the consequences of the
condition
c) Relating health needs to the goals of the family (both health and non health related goals)
d) Encouraging positive or wholesome emotional attitude toward the problem by affirming
the family’s capabilities/qualities/resources and providing information on available
options.
55 Focus on Interventions to Help the Family Perform the Health Tasks
2. Guide the Family on How to Decide on Appropriate Health Actions to Take- this can be
done through:
a) Identifying or exploring with the family the courses of action available and the resources
needed for each
b)Discussing the consequences of each course of action available
c) Analyzing with the family the consequences of inaction.

56 Focus on Interventions to Help the Family Perform the Health Tasks
3. Develop the Family’s Ability and Commitment to Provide Nursing Care Plan 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

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5. Facilitate the Family’s Capability to Utilize Community Resources for Health Care

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