FAMILY NURSING PROCESS • HOME AND ENVIRONMENT

- is the blueprint in the care that the nurse - information on housing and sanitation facilities,
design to systematically minimize or eliminate kind of neighborhood and availability of social,
the identified health and family nursing health, communication and transportation
problems through explicitly formulated facilities
outcomes of care (goals and objectives) and
deliberately chosen set of interventions, 1. Housing
resources, and evaluation criteria, standards • Adequacy of living space
and tools. • Sleeping in arrangement
• Presence of breathing or resting sites of
A. Family Health Assessment vector of diseases (e.g. mosquitoes,
• Tools for Assessment: roaches, flies, rodents, etc.)
- IDB (Initial Data Base) • Presence of accident hazard
• Food storage and cooking facilities
FAMILY STRUCTURE CHARACTERISTICS • Water supply-source, ownership, pot ability
AND DYNAMICS • Toilet facilities-type, ownership, sanitary
1. Members of the household and relationship condition
to the head of the family. • Garbage/refuse disposal-type, sanitary
2. Demographic data – age, sex, civil status, condition
position in the family
• Drainage System-type, sanitary condition
3. Place of residence of each member –
whether living with the family or elsewhere
2. Kind of Neighborhood, e.g. congested, slum
4. Type of family structure – e.g. patriarchal,
etc.
matriarchal, nuclear or extended
3. Social and Health facilities available
5. Dominant family members in terms of
4. Communication and transportation facilities
decision making especially on matters of
available
health care
6. General family relationship / dynamics-
HEALTH STATUS OF EACH FAMILY
presence of any obvious/ readily observable
MEMBERS
conflict between members; characteristics,
1. Medical Nursing history indicating current or
communication / interaction patterns among
past significant illnesses or beliefs and
members
practices conducive to health and illness
- cough, colds, fever
SOCIO- ECONIMIC AND CULTURAL
2. Nutritional assessment (especially for
CHARACTERISTICS
vulnerable or at risk members)
1. Income and expenses
• Anthropometric data
a. Occupation, place of work and income
- measures of nutritional status of
of each working member
children- weight, height, mid-upper arm
b. Adequacy to meet basic necessities
circumference
(food, clothing, shelter)
- risk assessment measures for obesity:
c. Who makes decision about money and
a. body mass index (BMI=weight in
how it is spent
kgs. divided by height in meters2)
2. Educational Attainment of each Member
b. waist circumference (WC: greater
3. Ethnic Background and Religious Affiliation
than 90 cm. in men and greater
4. Significant others-role (s) they play in
than 80 cm. in women)
family’s life
c. waist hip ration (WHR=waist
5. Relationship of the family to larger
circumference in cm. divided by hip
community-nature and extent of participation
circumference in cm. Central
of the family in community activities
obesity: WHR is equal to or greater
than 1.0 cm in men and 0.85 in
women)
 • dietary history
• Eating/ feeding habits/ practice

3. Developmental assessment of infant, toddlers

and preschoolers
- e.g. Metro Manila Developmental Screening
Test (MMDST).
a. Personal-Social: child’s ability to
socialize and take good care of himself
b. Fine motor adaptive: child’s ability to
see and use his hands
c. Language: child’s ability to hear, follow
directions, and speak
d. Gross motor: child’s ability to sit, walk,
jump

4. Risk factor assessment indicating presence of

major and contributing modifiable risk factors
for specific lifestyle diseases
- e.g. hypertension, physical inactivity,
sedentary lifestyle, cigarette/ tobacco
smoking, elevated blood lipids/ cholesterol,
obesity, diabetes mellitus, inadequate fiber
intake, stress, alcohol drinking, and other
substance abuse.

5. Physical Assessment indicating presence of

illness state/s (diagnosed or undiagnosed by
medical practitioners)
6. Results of laboratory/diagnostic and other
screening procedures supportive of
assessment findings.

VALUES HEALTH PRACTICES ON HEALTH

PROMOTION, MAINTENANCE AND DISEASE
PREVENTION
1. Immunization status of family members
2. Healthy lifestyle practices
3. Specify Adequacy of Rest and sleep
- Exercise/activities
- Use of protective measure
- e.g. adequate footwear in parasite-infested
areas; use of bed nets and protective
clothing in malaria and filariasis endemic
areas.
- Relaxation and other stress management
activities
4. Use of promotive-preventive health services
TYPOLOGY OF NURSING PROBLEMS IN C. Family size beyond what family
FAMILY NURSING PRACTICE resources can adequately provide
First Level Assessment D. Accident hazards specify.
I. PRESENCE OF WELLNESS CONDITION 1. Broken chairs
• stated as potential or Readiness 2. Pointed /sharp objects, poisons and
• a clinical or nursing judgment about a client in medicines improperly kept
transition from a specific level of wellness or 3. Fire hazards
capability to a higher level. 4. Fall hazards
• Wellness potential is a nursing judgment on 5. Others specify.
wellness state or condition based on client’s E. Faulty/unhealthful nutritional/eating
performance, current competencies, or habits or feeding techniques/practices.
performance, clinical data or explicit Specify.
expression of desire to achieve a higher level 1. Inadequate food intake both in quality
of state or function in a specific area on health and quantity
promotion and maintenance. 2. Excessive intake of certain nutrients
3. Faulty eating habits
Examples of this are the following: 4. Ineffective breastfeeding
A. Potential for Enhanced Capability for: 5. Faulty feeding techniques
1. Healthy lifestyle - e.g. nutrition/diet, F. Stress Provoking Factors. Specify.
exercise/activity 1. Strained marital relationship
2. Health maintenance/health 2. Strained parent-sibling relationship
management 3. Interpersonal conflicts between family
3. Parenting members
4. Breastfeeding 4. Care-giving burden
5. Spiritual well-being - process of client’s G. Poor Home/Environmental
developing/unfolding of mystery Condition/Sanitation. Specify.
through harmonious 1. Inadequate living space
interconnectedness that comes from 2. Lack of food storage facilities
inner strength/sacred source/God 3. Polluted water supply
(NANDA 2001) 4. Presence of breeding or resting sights
6. 6.Others. Specify_____ of vectors of diseases
B. Readiness for Enhanced Capability for: 5. Improper garbage/refuse disposal
1. Healthy lifestyle 6. Unsanitary waste disposal
2. Health maintenance/health 7. Improper drainage system
management 8. Poor lightning and ventilation
3. Parenting 9. Noise pollution
4. Breastfeeding 10. Air pollution
5. Spiritual well-being H. Unsanitary Food Handling and
6. Others Specify____ Preparation
I. Unhealthy Lifestyle and Personal
II. PRESENCE OF HEALTH THREATS Habits/Practices. Specify.
• conditions that are conducive to disease and 1. Alcohol drinking
accident or may result to failure to maintain 2. Cigarette/tobacco smoking
wellness or realize health potential. 3. Walking barefooted or inadequate
footwear
Examples of this are the following: 4. Eating raw meat or fish
A. Presence of risk factors of specific 5. Poor personal hygiene
diseases (e.g. lifestyle diseases, 6. Self-medication/substance abuse
metabolic syndrome) 7. Sexual promiscuity
B. Threat of cross infection from 8. Engaging in dangerous sports
communicable disease case 9. Inadequate rest or sleep
 10. Lack of /inadequate exercise/physical D. Additional member – e.g. newborn,
activity lodger
11. Lack of/relaxation activities E. Abortion
12. Non- use of self-protection measures F. Entrance at school
(e.g. non- use of bed nets in malaria G. Adolescence
and filariasis endemic areas). H. Divorce or separation
J. Inherent Personal Characteristics – I. Menopause
e.g. poor impulse control J. Loss of job
K. Health History, which may K. Hospitalization of a family member
Participate/Induce the Occurrence of L. Death of a member
Health Deficit - e.g. previous history of M. Resettlement in a new community
difficult labor. N. Illegitimacy
L. Inappropriate Role Assumption - e.g. O. Others, specify. ___________
child assuming mother’s role, father not
assuming his role. Second Level Assessment
M. Lack of Immunization/Inadequate I. INABILITY TO RECOGNIZE THE PRESENCE
Immunization Status Specially of OF THE CONDITION OR PROBLEM due to:
Children A. Lack of or inadequate knowledge
N. Family Disunity B. Denial about its existence or severity as a
1. Self-oriented behavior of member(s) result of fear of consequences of
2. Unresolved conflicts of member(s) diagnosis of problem, specifically:
3. Intolerable disagreement 1. Social-stigma, loss of respect of
O. Others. Specify. _________ peer/significant others
2. Economic/cost implications
III. PRESENCE OF HEALTH DEFICITS 3. Physical consequences
• Instances of failure in health maintenance 4. Emotional/psychological
issues/concerns
Examples include: C. Attitude/Philosophy in life, which hinders
A. Illness states, regardless of whether it recognition/acceptance of a problem
is diagnosed or undiagnosed by D. Others. Specify _________
medical practitioner.
B. Failure to thrive/develop according to
normal rate II. Inability to make decisions with respect to
C. Disability – whether congenital or taking appropriate health action due to:
arising from illness; A. Failure to comprehend the
transient/temporary (e.g. aphasia or nature/magnitude of the
temporary paralysis after a CVA) or problem/condition
permanent (e.g. leg amputation B. Low salience of the problem/condition
secondary to diabetes, blindness from C. Feeling of confusion, helplessness and/or
measles, lameness from polio) resignation brought about by perceive
magnitude/severity of the situation or
IV. PRESENCE OF STRESS problem, i.e. failure to breakdown
POINTS/FORESEEABLE CRISIS problems into manageable units of attack.
SITUATIONS D. Lack of/inadequate knowledge/insight as
• anticipated periods of unusual demand on the to alternative courses of action open to
individual or family in terms of them
adjustment/family resources. E. Inability to decide which action to take
from among a list of alternatives
Examples of this include: F. Conflicting opinions among family
A. Marriage members/significant others regarding
B. Pregnancy, labor, puerperium action to take.
C. Parenthood
 G. Lack of/inadequate knowledge of despair, rejection) which his/her
community resources for care capacities to provide care.
H. Fear of consequences of action, H. Philosophy in life which negates/hinder
specifically: caring for the sick, disabled, dependent,
1. Social consequences vulnerable/at risk member
2. Economic consequences I. Member’s preoccupation with on
3. Physical consequences concerns/interests
4. Emotional/psychological J. Prolonged disease or disabilities, which
consequences exhaust supportive capacity of family
I. Negative attitude towards the health members.
condition or problem-by negative attitude K. Altered role performance, specify.
is meant one that interferes with rational 1. Role denials or ambivalence
decision-making. 2. Role strain
J. Inaccessibility of appropriate resources 3. Role dissatisfaction
for care, specifically: 4. Role conflict
1. Physical Inaccessibility 5. Role confusion
2. Costs constraints or economic/financial 6. Role overload
inaccessibility L. Others. Specify.____
K. Lack of trust/confidence in the health
personnel/agency IV. INABILITY TO PROVIDE A HOME
L. Misconceptions or erroneous information ENVIRONMENT CONDUCIVE TO HEALTH
about proposed course(s) of action MAINTENANCE AND PERSONAL
M. Others specify._________ DEVELOPMENT due to:
A. Inadequate family resources specifically:
III. INABILITY TO PROVIDE ADEQUATE 1. Financial constraints/limited financial
NURSING CARE to the sick, disabled, resources
dependent or vulnerable/at risk member of 2. Limited physical resources – e.i. lack of
the family due to: space to construct facility
A. Lack of/inadequate knowledge about the B. Failure to see benefits (specifically long
disease/health condition (nature, severity, term ones) of investments in home
complications, prognosis and environment improvement
management) C. Lack of/inadequate knowledge of
B. Lack of/inadequate knowledge about child importance of hygiene and sanitation
development and care D. Lack of/inadequate knowledge of
C. Lack of/inadequate knowledge of the preventive measures
nature or extent of nursing care needed E. Lack of skill in carrying out measures to
D. Lack of the necessary facilities, improve home environment
equipment and supplies of care F. Ineffective communication pattern within
E. Lack of/inadequate knowledge or skill in the family
carrying out the necessary intervention or G. Lack of supportive relationship among
treatment/procedure of care (i.e. complex family members
therapeutic regimen or healthy lifestyle H. Negative attitudes/philosophy in life which
program). is not conducive to health maintenance
F. Inadequate family resources of care and personal development
specifically: I. Lack of/inadequate competencies in
1. Absence of responsible member relating to each other for mutual growth
2. Financial constraints and maturation (e.g. reduced ability to
3. Limitation of luck/lack of physical meet the physical and psychological
resources needs of other members as a result of
G. Significant persons unexpressed feelings family’s preoccupation with current
(e.g. hostility/anger, guilt, fear/anxiety, problem or condition.
J. Others specify. _________
V. FAILURE TO UTILIZE COMMUNITY
RESOURCES FOR HEALTH CARE due to:
A. Lack of/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
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constraints
2. Physical inaccessibility
H. Lack of or inadequate family resources,
specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines
prescribe
I. Feeling of alienation to/lack of support
from the community, e.g. stigma due to
mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which
hinders effective/maximum utilization of
community resources for health care
K. Others, specify __________
ASSESSMENT
• measuring status of the family
• ability to maintain itself
• ability to maintain wellness
• prevent, control and resolve problems
• data are compared with the norms and
standards