CHN-PRE FINAL Reviewer

Tools for assessment TYPOLOGY OF NURSING

PROBLEMS IN FAMILY NURSING
A. Family interviewing . The community health PRACTICE
nurse uses
general system and communications concepts NURSING PROBLEM is a situation or condition
to conceptualize which interferes
the health needs of families and to assess with the promotion and/or maintenance of
families’ responses health and recovery
to events such as birth, retirement, or chronic from illness or injury, and which is subject to
illness. change/modification
through nursing intervention.
Critical components of the family interview:
On the basis of the health tasks a family must
Manners – set the tone for the interview and assume, defined
begin the by Freeman, the following which constitute the
development of a therapeutic relationship. range of problems a
Introduces community health nurse encounters in family
himself, always addresses the client by care practice:
name/title, keep
appointments, explains the reason for the HEALTH THREATS
interview or visits,
and brings a positive attitude. 1. Family history of hereditary disease [ex:
diabetes, hypertension,
Therapeutic questions- family expectations of cancer]
the home
visit; challenges, concerns, and problems 2.Threat of cross infection from a
encountered by communicable disease case
the family at the time of the interview ; sharing
of 3.Family size beyond what family resources can
information. adequately provide

Therapeutic conversations- is focused and 4.Accident hazards [ex: broken stairs, pointed
planned and sharp objects, poisons
engages the family. The nurse must listen and & medicines improperly kept, fire hazards, fall
remember hazards]
that even one sentence has the potential to
heal or help a 5. Nutrition
family member.
A.Inadequate food intake both in quality &
Genogram and ecomap – this tool provide quantity
essential
information on family structure and are efficient B.Excessive intake of certain nutrients
way to
gather information, such as family composition, C.Faulty eating habits
background,
and basic health status, in a way that engages 6. Stress-provoking factors
the family in the interview process.
Strained marital relationships
Commending family or Individual strengths. -
identifying at least 2 strength areas and, during Immature parents
each family interview,
sharing with them with the family or individual. Strained parent-sibling relationship
Interpersonal conflicts between family
members
 Illness states, regardless of whether it is
diagnosed or
7. Poor environmental sanitation undiagnosed

Inadequate living space Failure to thrive/develop according to expected

rate
Inadequate personal belongings/utensils
Personality disorders
Lack of food storage facilities
Alcoholism
Polluted water supply c. Drug addiction

Improper refuse disposal Neurosis

d. Psychosis
Unsanitary waste disposal
C. FORESEEABLE CRISIS situation – anticipated
Presence of breeding places of insects and periods of unusual
rodents demand on the individual or family in terms of
adjustment/family
Cont. resources

7.Poor environmental sanitation Marriage

h. Poor lighting & ventilation Pregnancy

i. Noise pollution Additional family member

j. Air pollution Abortion

k. Unsanitary food handling & preparation Entrance at school

8. Personal habits/practices C. FORESEEABLE CRISIS situation – anticipated

periods of unusual
Excessive drinking of alcohol demand on the individual or family in terms of
adjustment/family
Excessive smoking resources

Walking barefooted 6. Adolescence

Eating raw meat/fish 7. Loss of job

Poor personal hygiene 8. Death of family member

9. Inherent personality characteristics [ex: high- 9. Resettlement in a new community

strung individual]
SECOND LEVEL ASSESSMENT
10. Health history which may precipitate/induce
the occurrence of I. Inability to recognize presence of a problem
a health problem [ex: previous history of due to:
difficult labor]
A.Ignorance of facts
11. Inadequate immunization status especially
children B.Fear of consequence of diagnosis of problem

B. HEALTH DEFICITS are instances of failure in 1.Social – stigma, loss of respect of

health maintenance peer/significant others
2.Economic – cost
C.Ignorance of the nature and extent of the
3.Physical/psychological nursing care needed

A. Attitude/philosophy in life D.Lack of necessary facilities [ex: equipment and

supplied for care]
II. Inability to make decision with respect to
seeking appropriate E. Inadequate family resources for care
health due to:
1.Responsible family member
A.Failure to comprehend the nature,
magnitude/scope of the 2.Financial
problem
3.Physical resources – isolation room
B.Feeling of confusion and resignation brought
about by failure to F. Negative attitude towards the sick/disabled
break down problems into manageable units of or dependent
attack members of the family

C.Ignorance of community resources for care G. Presence of personal/psychological conflicts

D. Fear of consequences of action H. Attitude/philosophy in life

1.Social I. Self-oriented behavior of family members

2.Economics IV. Inability to provide a home environment

which is conducive to
3.Physical/psychological health maintenance and personal
development due to:
E. Negative attitude towards health problem –
by negative attitude to A. Inadequate family resources
mean that there is interference with rational
decision making 1.Financial

F. Inaccessibility of appropriate resources of 2.Responsible/competent family member

care
3.Physical [ex: lack of space to construct
1.Physical – location facilities]

2.Cost B. Failure to see benefits [especially long-term

ones] of investment in
G. Lack of confidence in health personal/agency home

III. Inability to provide nursing care to the C. Ignorance of importance of hygiene &
sick/disabled or sanitation
dependent member of the family due to:
D. Presence of personal/psychological conflicts
A.Ignorance of the facts [nature, severity,
complications, prognosis 1.Identity crisis/role confusion
and management] of the disease/health
condition; child 2.Jealousy/rivalry
development and child care
3.Guilt feelings
B.Lack of knowledge and skill in carrying out the
necessary E. Ignorance of preventive measures
treatment/procedure/care
F. Family disunity
 1. Nature of problem presented
1.Self-oriented behavior of members Scale:
Health threat= 2
2.Intolerable disagreements Health deficit= 3
Foreseeable crisis= 1
3.Lack of support to member in crisis Weight
1
V. Failure to utilize resources for health care
due to: 2. Modifiability of the problem
Scale:
Ignorance or lack of community resources for Easily modifiable= 2
health care Partially modifiable = 1
Not modifiable = 0
Failure to perceive the benefits of health
care/services Weight
2
Lack of trust/confidence in agency/personnel
3. Preventive potential
Previous unpleasant experience with health Scale:
worker High= 3
Moderate= 2
E. Fear of consequence of action [preventive, Low= 1
diagnostic,
therapeutic, rehabilitative] Weight
1
Physical/psychological
4. Salience
Financial Scale:
A serious problem; immediate attention
Social {loss of esteem of peer/significant others needed= 2

F. Unavailability of required care/service A problem but not needing immediate

attention= 1
G. Inaccessibility of required care service
Attention not a felt need/problem= 0
Cost
Weight
Physical location 1

H. Lack of or inadequate family resources Scoring

1. Decide on a score for each of the criteria.
Manpower [ex: baby sitter} 2. Divide the score by the highest possible score
and multiply by the
Financial [ex: cost of prescribed medicine] weight.
Score
I. Feeling of alienation/lack of support from the ----------------- X Weight
community [ex: Highest Score
mental illness]
3. Sum up the scores for all the criteria. The
J. Attitude/philosophy in life highest score is 5, equivalent
to the total weight.
Scale for Ranking a Family Health Problem
according to 4. The higher the score (near 5 and above) of a
priorities given problem, the more
likely it is taken as a PRIORITY.
CRITERIA
5. With the available scores, the nurse then family’s perception of a problem. As a general
RANKS health problems accordingly rule, the family’s
concerns and felt needs require priority
Criteria in Different Priorities attention

1. Nature of the Problem Presented Is the set of actions the nurse decides to
implement to be able to
Categorized whether a Health Threat, Health resolve identified family health and nursing
Deficit or problems.
Foreseeable Crisis
FAMILY Coping Index
2. Modifiability of the Problem
This tool is based on the premise that nursing
Refers to the probability of success in action may
minimizing alleviating or help a family in providing for a health need or
totally eradicating the problem through health resolving a
intervention health problem by promoting the family’s
capacity.
Factors:
It provides a system of identifying areas that
Current knowledge, technology and may require
interventions to manage nursing intervention and areas of family
the problem strengths that
may be used to help the family deal with health
Resources of the family (physical, financial, needs and
manpower) problems.

Resources of the nurse (knowledge, skills, time) 9 Areas of Assessment of the Family
Coping Index
Resources of the community (facilities &
community Physical independence refers to the family
organization) member’s
mobility and ability to perform activities of daily
3. Preventive Potential living,
such as feeding themselves and performing
Refers to the nature and magnitude of the activities
future problem that necessary for personal hygiene.
can be minimized or totally prevented if
intervention is done in Therapeutic competence is the family’s ability
the problem. to comply
with prescribed or recommended procedures
Factors: and
treatments to be done at home, which include
 Gravity and severity of the problem medications, dietary recommendation,
 Duration of the problem exercises,
 Current management application of wound dressing, and use of
 Expose of any high risk group prosthetic
devices and other adaptive appliances such as
4. Salience wheelchairs and walkers.

Refers to the family perception & evaluation of 3. Knowledge of health condition means
the problem in understanding the
terms seriousness & urgency of attention health condition or essential care according to
needed. the
developmental stages of family members.
To determine the score for Salience, the nurse Example are
evaluates the
degree of knowledge of responsible members in
terms of 3. Family environment refers to the physical
communicability of diseases. environment inside the family’s
home/residence
4. Application of principles of personal and and its neighborhood.
general hygiene
includes practice of general health promotion 4. Family health and health behavior take into
and account the family’s activities of daily living,
recommended preventive measures. self-care, risk behaviors, health history, current
health status, and health care resources (home
5. Health care attitudes refer to the family’s remedies and health services).
perception of
health care in general. Family data analysis – organizes data into
clusters(data
6. Emotional competence is concerned with the synthesis) and set aside data that may be
degree of emotional maturity of family considered
members irrelevant at this point. Inaccurate or conflicting
according to their developmental stage. data are
validated with the family respondent(s).
7. Family living patterns refer to interpersonal
relationships among family members Data analysis is done by comparing findings with
management accepted
of family finances and the type of discipline in standards for individual family members and for
the the family
home. unit. Current information should be compared
with the
8. Physical environment includes home, school, previous information available.
work, and community environment that may
influence the health of members. B. FAMILY NURSING DIAGNOSIS

9. Use of community facilities is the ability of Proposed by NANDA.

the
family to seek and utilize, as needed, both Actual and Potential problem.
government-run and private health, education,
and Family coping Index – help family in providing
other community services. for a
health need or resolving a health problem by
Family Data Analysis promoting family’s coping capacity.

Family structure and characteristics are Family coping index – provides a system of
reflected in data identifying
on household membership and demographic areas that may require nursing intervention and
characteristics, family members living outside areas
the of the family strengths that may be used to help
household, family mobility, and family dynamics the
family deal with health needs and problem.
Socioeconomic characteristics include data on
social B. Family Nursing Diagnosis
integration (ethnic origin, languages and/or
dialects Examples for family nursing diagnosis:
spoken, and social networks), educational
experiences and Parental role conflict.
literacy, work history, financial resources,
leisure time Family Processes, Dysfunctional: Alcoholism (
interests, and cultural influences, including substance abuse ).
spirituality or
religious affiliation. Family Processes, Interrupted.
 the family to avail of maternal and early child
Family Processes, Readiness for Enhanced. care
services.
Family coping, ineffective.
Developmental interventions aim to improve
Family coping, potential for growth. the capacity
of the family to provide for its own health
Examples for family nursing diagnosis: needs, such as
guiding the family to make responsible health
Parental role conflict. decisions.

Parent/infant/child attachment, altered, risk 4. Implementing the plan of care

for.
It involves providing direct nursing care, helping
Parenting, altered. family members
do what is necessary to meet health needs and
Parenting, altered, risk for. problems, or
referring the family to another health worker or
Role performance, altered agency.

Social interaction, impaired. Promotive

Social isolation. Preventive

C. Formulating Family Nursing Care Plan Curative

(p.101)
Rehabilitative
1. Priority setting
5. Evaluation
Family safety
It is determining the value of nursing care that
Family perception has
been given to a family. The product of this step
Practicality is
used for further decision making to terminate,
Projected effects continue, or modify the intervention(s).
Well-formulated goals and objectives in the
2. Establishing goals and objectives nursing
care plan serve the framework for evaluation
SMART

3. Selecting appropriate family nursing

interventions/strategies
2 Ways of conducting an evaluation
Supplemental interventions – are actions that
the nurse Formative evaluation is judgment made about
performs on behalf of the family when it is effectiveness of nursing interventions as they
unable to do are
things for itself ( nursing care to the sick or implemented. (Ongoing and continuing
disabled evaluation)
family member).
Summative evaluation is determining the end
Facilitative interventions refer to actions that results of
remove family nursing care and usually involves
barriers to appropriate health action, such as measuring
assisting outcomes or the degree to which goals have
been achieve.
 Family health and health behavior
Aspect of Evaluation useful in family
healthcare Medical History – history of certain disease,
family
1.Effectiveness is determination of whether member with disease.
goals and
objectives were attained. It answers the Resources available in community for the use by
question, the family.
“Did we produce the expected results?” or “Did
we 5 Resources available in the community
attain our objectives?”
man/manpower
2.Appropriateness refers to the suitability of the
goals/objectives and interventions to the Money
identified
family health needs. It answers the question, “ Machine
Are
goals/objectives and interventions correct in Materials
relation
to the family health needs we intend to address. methods

3. Adequacy means the degree of sufficiency of

goals/objectives and interventions in attaining
the desired
change in the family. It answers the question,
Were our
interventions enough to bring about the desired
change in
the family?

4. Efficiency is the relationship of resources use

to attain
the desired outcomes. It answers the question,
“Are the
outcomes of family nursing care worth the
nurse’s time,
effort, and other resources?”

System of organizing family data

Family structure and characteristics –

types of families

Socioeconomic characteristics – poverty

level, educational attainment, nature
occupation of members of the family

Family environment- assessment

according to environmental sanitation,
availability of toilet, water and food
sanitation