UNIT 4: FAMILY NURSING PROCESS 3.

Enables nurses to use time and resources

efficiently to both their own and their client’s
benefit – timeframe; span of evaluating what
REVIEW OF THE NURSING PROCESS will be the response of the client.
▪ It is a scientific and systematized approach to
health to care for individuals, families, and THE STEPS OF THE NURSING PROCESS
illness prevention ▪ Assessment
▪ It is the means by which nurses address the ▪ Nursing Diagnosis
health needs and problems of their clients ▪ Planning
▪ It is a systematic, client-centered method or ▪ Implementation
structuring the delivery of nursing care ▪ Evaluation
▪ Nursing process is a systematic, rational method
of planning and providing individualized nursing Nursing Assessment: The process of collecting,
care. validating and recording data about a client’s health
status. It identifies patient’s strengths and limitations
THE PURPOSE OF NURSING PROCESS and is done continuously throughout the nursing
▪ To identify client’s health status, actual or process.
potential healthcare problems or need.
▪ To establish plans to meet the identified needs Nursing Diagnosis: In this phase the nurse sort, clusters
and to deliver specific interventions to meet and analyzes data. Nursing diagnoses are identified
those needs. through actual and potential health problems or
▪ It provides a framework in which to practice responses to life processes.
nursing.
Types of nursing diagnosis: [guidelines]
CHARACTERISTICS OF A NURSING PROCESS: It can be ACTUAL, POTENTIAL or WELLNESS diagnosis:
1. ACTUAL – identifies an occurring health
▪ Dynamic and cyclic – sequential steps [wrong problem
problem = reassessment] and ever-changing 2. POTENTIAL – identifies a high-risk health
depending on the arising problems if necessary. problem
▪ Patient centered – presented and manifested of 3. WELLNESS‐ focused on promoting or enhancing
the client to formulate plans and objectives a patient’s level of wellness.
directed to the problems assessed.
▪ Goal directed Planning: Planning expected outcomes to resolve or
▪ Open and Flexible – reassessment for other minimize the identified problems of the client. In
problems [prioritization]. collaboration with the client, the nurse develops specific
▪ Problem Oriented nursing intervention for each nursing diagnosis.
▪ Planned
▪ Universally accepted Implementation: Also called intervention; putting the
▪ Interpersonal and collaborative nursing care plan into action to achieve goals and
▪ Holistic outcomes as you implement your plan, you continue to
▪ Systematic assess your patient’s responses and modify plan as
needed. The doing phase of the nursing process. Care
Benefits of Nursing Process done should always be documented.
1. Improves the quality of care that the client
receives – since we are identifying their needs, Evaluation: Assessing the client’s response to nursing
design strategies and objectives that should be interventions and then comparing the response to the
done directed to the quality of care; core is the goals or outcome criteria written in the planning phase
assessment as the basis of the delivery of
nursing care. FAMILY
2. Ensures a high level of client participation
together with continuous evaluation designed FAMILY HEALTH
to meet the client’s unique needs
 ▪ The continuing ability to meet defined functions
in interaction with other social, political, DATA ANALYSIS – sorting out and classifying or
economic and health system. grouping data by type of nature.
▪ Possessing the abilities and resources to
accomplish family developmental tasks. ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS
FAMILY HEALTH NURSING PROCESS 1. Criteria for analysis
▪ Family nursing process is the same, whether the 2. Process for analysis
focus is the family as patient or as environment. o sorting of data
The goal is to help the family reach and o clustering of related cues
maintain its maximum health in a given o distinguishing relevant from irrelevant
situation. cues
PRINCIPLES OF FAMILY HEALTH CARE o identifying patterns
1. Establishing good professional relationship with o comparing patterns
the family o interpreting results of comparison
2. Proper education and guidance should be o making inferences and drawing
provided conclusions
3. Gather all relevant information about family to
identify problem and set priorities
4. Provide need-based support and services to the NURSING DIAGNOSIS
family to improve their health status
5. Health care services should be provided to the ▪ The end result of the secondary level assessment
family irrespective of their age, sex, income, and a set of family nursing problems for each health
religion, etc. condition or problem
6. Duplication of health services should be avoided ▪ First major phase of nursing process in family health
7. Proper health message to be communicated to nursing
family in every contact ▪ It involves a set of action by which the nurse
measures the status of the family as a client. Its
STEPS OF FAMILY HEALTH NURSING PROCESS ability to maintain wellness, prevent, control or
resolve problems in order to achieve health and
1. Assessment wellness among its members
2. Formulation of family nursing ▪ Data about present condition or status of the family
problem/diagnosis are compared against the norms and standards of
3. Planning personal, social, and environmental health, system
4. Implementation integrity and ability to resolve social problems. The
5. Evaluation phase norms and standards are derived from values,
beliefs, principles, rules or expectation.
ASSESSMENT

Family Health Nursing Assessment TWO MAJOR TYPES OF ASSESSMENT:

▪ This involves a set of actions by which the nurse 1. FIRST LEVEL ASSESSMENT- a process whereby
measures the status of the family as a client, its existing and potential health conditions or problems
ability to maintain itself as a system and of the family are determined (WS, HT, HD, SP or FC)
functioning unit, and its ability to maintain 2. SECOND LEVEL ASSESSMENT- defines the nature or
wellness, prevent control and resolve problems type of nursing problem that family encounters in
in order to achieve health and well-being performing health task with respect to given health
among its members. condition or problem and etiology or barriers to the
Data Collection Data Analysis Diagnosis family’s assumption of the task

DATA COLLECTION DATA COLLECTION METHODS:

Two important things to ensure Effective and Efficient
Data Collection in Family Nursing Practice: SELECT APPROPRIATE METHOD
1. Identify the types of kinds of data needed
2. Specify the methods of data gathering and OBSERVATION
necessary tools for gathering data ▪ It is done through use of sensory capacities
 ▪ The nurse gathers information about the family’s LABORATORY/ DIAGNOSTIC TEST
state of being and behavioral responses. ▪ Laboratory examinations to confirm the
▪ The family’s health status can be inferred from the diagnosis of the patient, such as Blood test,
signs /symptoms of problem areas within the urine test, radiological examination.
following areas:
▪ communication and interaction patterns expected, CONTENT OF FAMILY ASSESSMENT
used, and tolerated by family members
▪ role perception / task assumption by each member
including decision making patterns 1. INITIAL DATA BASE FOR FAMILY NURSING PRACTICE
▪ conditions in the home and environment ▪ Family Structure, characteristics and dynamics
▪ Data gathered though this method have the ▪ Socio-economic and cultural characteristics
advantage of being subjected to validation and ▪ Home and environment
reliability testing by other observers. ▪ Health status of each member
▪ Values and practices on health
PHYSICAL EXAMINATION promotion/maintenance and disease
▪ Health assessment of every member of the family, prevention
significant data about the health status of individual
members can be obtained through direct 2. FAMILY STRUCTURE CHARACTERISTICS AND
examination through IPPA, measurement of specific DYNAMIC
body parts and reviewing the body systems. This includes the following:
▪ Data gathered form substantive part of first level ▪ composition and demographic data of the
assessment which may indicate presence of health members of the family/household
deficits (illness state) ▪ their relationship to the head and place of
residence
INTERVIEW ▪ the type of family
▪ Productivity of interview process depends upon the ▪ family interaction/communication
use effective communication techniques to elicit ▪ Decision making patterns and dynamics
needed response.
▪ Problems encountered during interview: 3. SOCIO-ECONOMIC AND CULTURAL
▪ How to ascertain where the client is in terms of CHARACTERISTICS
perception of health condition or problems and the This includes the following:
patterns of coping utilized to resolve them ▪ Income and Expenses
▪ Tendency of community health worker to readily ▪ Occupation, place of work, and income of each
give out advice, health teachings or solutions once working member
they have identified the health condition or ▪ Adequacy to meet basic necessities
problems. ▪ Who makes decisions about money and how it
▪ Provisions of models for phrasing interview is spent
questions utilization of deliberately chosen ▪ Educational attainment of each family member
communication techniques for an adequate nursing ▪ Ethnic background and religious affiliations
assessment. ▪ Significant others-roles they play in the family’s
▪ Confidence in the use of communication skills life
▪ Being familiar with and being competent in the use ▪ Relationship of the family to the larger
of type of question that aim to explore, validate, community (membership in organizations)
clarify, offer feedback, encourage verbalization of
thought and feelings. 4. HOME AND ENVIRONMENT
a. Housing:
RECORDS REVIEW ▪ Adequacy of living space
▪ Gather information through reviewing existing ▪ Sleeping arrangement
records and reports pertinent to the client. ▪ Food storage and cooking facilities
▪ Individual clinical records of the family members, ▪ Water supply, toilet facilities
laboratory and diagnostic reports, immunization ▪ Presence of accident hazards
records about home and environmental conditions. ▪ Garbage disposal
b. Kind of neighborhood
 c. Social and Health Facilities competencies expression of client’s
d. Communication and transportation facilities desire
available ▪ e.g. Potential for Enhanced
Capability for parenting
5. HEALTH STATUS OF EACH MEMBER
▪ Medical and nursing history indicating current 2. Presence of Health Threats
and past significant illness or beliefs and Readiness for Enhanced Wellness State
practices conductive to health and illness It is a nursing judgement on wellness state or
▪ Nutritional and developmental status condition based on client’s current
▪ Developmental assessment of infants, toddlers competencies or performance, clinical data and
and preschoolers explicit expression of desire to achieve higher
▪ Risk factor assessment level or function in a specific area on health
▪ Physical assessment findings promotion and maintenance.
▪ Significant results of laboratory/diagnostic o e.g Readiness for Enhanced Capability
tests/screening procedures for Healthy Lifestyle
▪ Decision making on which or whom to seek
advice regarding health 3. Presence of Health Threats
These are conditions that are conducive to
6. VALUES AND PRACTICE ON HEALTH disease and accident, or may result to failure to
PROMOTION/MAINTENANCE AND DISEASE maintain wellness or realize health potential.
PREVENTION o e.g. Presence of Risk Factors of specific
▪ Immunization status of the family members disease, accident hazards, poor home/
▪ Healthy lifestyle practices environmental conditions, family
▪ Adequate of: rest/sleep, exercise/activities, use history of hereditary disease, threat of
of protective measures, relaxation and stress cross infection, faulty eating habits,
management poor environmental sanitation,
▪ Utilization of health care facilities unhealthy lifestyle/personal habits

FORMULATION OF FAMILY NURSING 4. Presence of Health Deficits

PROBLEM/DIAGNOSIS These are instances of failure in health
maintenance
Family profile and diagnosis o e.g. Illness states, diagnosed or
▪ Family profile implies brief description of family undiagnosed by medical practitioner,
structure and characteristics, family life cycle disability, transient (aphasia or
and culture, socio economic conditions temporary paralysis after a CVA),
environmental factors health and medical permanent (leg amputation secondary
history etc. Family health diagnosis is the to diabetes, lameness from polio)
written statement of family health problems
which are assessed from analysis of data 5. Presence of Stress Points/Foreseeable Crisis
collected. Anticipated periods of unusual demand on the
individual or family in terms of
FIRST LEVEL ASSESSMENT adjustment/family resources.
Name or Categories of Health Problems o e.g. marriage, pregnancy, parenthood,
1. Presence of Wellness Condition divorce, separation, loss of job,
Stated as Potential or Readiness menopause death
o A clinical or nursing judgment about a
client transition form a specific level of SECOND LEVEL ASSESSMENT
wellness or capability to a higher level Five Main Types:
(NANDA, 2001) 1. Inability to recognize the presence on the
Wellness Potential condition/problem due to…
o It is a nursing judgement on wellness 2. Inability to make decisions with respect to
state or performance current taking appropriate health action due to…
 3. Inability to provide nursing care to the sick, provide our families with adequate support to
disabled, or dependent member of the family cope with developmental or situational crisis.
due to…
4. Inability to provides a home environment which Modifiability of the condition or problem
is conducive to health maintenance and ▪ This refers to the probability of success in
personal development due to… enhancing the wellness state improving the
5. Failure to utilize community resources for condition minimizing, alleviating or totally
health due to… eradicating the problem through intervention.
▪ This is possibility of resolving the problem
PLANNING PHASE through nursing intervention which includes:
o Current knowledge, technology and
(Family health and nursing care plan formulation) interventions to enhance the wellness
▪ It is based on the analysis of diagnosed health state or manage the problem.
problems and assessment of family’s ability to o Resources of the family
resolve problems, establish priorities, setting goals o Resources of the nurse
and objectives, formulating family health nursing
o Resources of the community
care plan.
Preventive potential
1. Analysis of diagnosed health problems and
▪ This refers to the nature and magnitude of
assessment of family’s ability to resolve
future problem that can be minimized or totally
problems Family’s ability to resolve health
prevented if interventions are done on the
problems can be assessed on the basis of:
condition or problem under consideration.
a. ability to recognize the presence of
▪ It refers to the severity of the consequence of
health problems
the problem and nature and magnitude of the
b. ability to make decisions for taking
problem, interventions within available
appropriate health action
resources whether the problem can be
c. ability to provide desired care to the
prevented, eradicated or controlled. These are:
sick disabled
o Gravity or severity of the problem
d. ability to maintain environment
It refers to the progress of the
conducive to health promotion
disease/problem indicating extent of
maintenance and personnel
damage on the patient/family; also
development
indicates prognosis, reversibility or
e. ability to utilize community for health
modifiability of the problem. In general,
care
the more severe the problem is, the
lower is the preventive potential of the
2. Establish priorities -means rank ordering of the
problem.
health problems.
o Duration of the problem
This refers to the length of time the
FOUR CRITERIA FOR DETERMINING PRIORITIES
problem has existed. Generally
speaking, duration of the problem has a
Nature of the condition or problem direct relationship to gravity; the nature
▪ These are categorized into wellness of the problem is variable that may,
state/potential, health threat, health deficit or however, alter this relationship.
foreseeable crisis. Because of this relationship to gravity of
▪ The biggest weight is given to the wellness state the problem, duration has also a direct
or potential because of the premium on client’s relationship to preventive potential.
effort or desire to sustain/maintain high level of o Current management
wellness. refers to the presence and
▪ The same weight is given to health deficit appropriateness of intervention
because of its sense of clinical urgency, which measures instituted to enhance the
may require immediate intervention. wellness state or remedy the problem.
▪ Foreseeable crisis is given the least weight The institution of appropriate
because culture linked variables/factors usually
 intervention increases condition’s
preventive potential. SETTING GOALS AND OBJECTIVES
o Exposure of any vulnerable or high-risk
group ▪ Formulation of Goals and Objectives
Increases the preventive potential of ▪ Formulating Goals and Objective for Health
condition or problem Promotion and Maintenance
o Salience ▪ Goal is a general statement of the condition or
the state to be brought about by specific course
This refers to the family’s perception
of action
and evaluation of the condition or
problem in terms of seriousness and
PARTS OF A NURSING OBJECTIVE
urgency of attention needed or family
readiness. It refers to the family’s 1. Time frame and condition
perception about the seriousness of the 2. Terminal behavior or expected outcome
problem 3. Criteria of acceptable performance
Example: After 2-3 months of the family will be able to
Prioritization of Health Problem maintain ability to recognize signs of health and
Criteria Weight development
▪ Objective refers to more specific statements of
Nature or conditions of the problem 1
the desired results or outcomes of care.
Scale: Example: At the end of 2-3 months the family will be
able to:
▪ wellness state (3) 1. Identify signs of health and development
▪ health deficit (3) 2. Perform usual activities for health and
▪ health threat (2 development
▪ foreseeable crisis (1)
Modifiability of the problem 2 ▪ They specify the criteria by which the degree of
effectiveness of care is to be measured.
Scale:
▪ A cardinal principle in goal setting states that
▪ easily modifiable (2) goal must be set jointly with the family. This
▪ partially modifiable (1) ensures family commitment to realization.
▪ not modifiable (1) ▪ Basic to the establishment of mutually
Preventive potential 1 acceptable goals is the family’s recognition and
acceptance of existing health needs and
Scale: problems.
▪ high (3)
▪ moderate (2)
▪ low (1)
Salience 1

Scale:

▪ needs immediate attention (2)

▪ does not need immediate
attention (1)
▪ not perceived as a problem or
condition needing change (0)

SCORING:
1. Divide the score for each of the criteria
2. Divide the score by the highest possible score and
multiply by the weight
3. Sum up the scores for all the criteria. The highest
score is 5, equivalent to the total weight