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Cristina Marie Manzano, RN, RM, MAN Assistant Professor II, School of Nursing Global City Innovative College The Family Health Nursing Process

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Nursing Process in Family Health Reflect sequential progress, interdependent and overlapping in their execution

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Sequence of Activities in FHN Establishes a working relationship with the client Conducts an initial assessment Categorizes Health Problems Determine the nature and extent of the familys performance of the health tasks on each of the health problems Determine priorities among the list of health problems Ranks health problems according to priorities. Decides on what problems to tackle in the order of immediacy/urgency Defines nursing objectives in realistic measurable terms Plans approaches, strategies of action Implements the nursing care plan Evaluates the effectiveness of the interventions Re-defines nursing problems and re-formulates

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Initial Data Base for Family Nursing Practice

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Family Structures, Characteristics & Dynamics Members of the household and relationship to the head of the family Demographic Data or Rank in the family Place of residence of each member Type of family structure and government Dominant family members in terms of decision making in matters of health care General family relationship/ dynamics

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Socio-Economic & Cultural Factors Income and Expenses Educational attainment of each member Ethnic Background and Religious Affiliation Significant Others Relationship of the family to larger community

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Home and Environment Housing Kind of neighborhood Social & Health facilities available Communication & Transportation Facilities Available

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Health Status of Each Family Members Medical & Nursing history Nutritional Assessment Developmental Assessment Risk Factor Assessment Physical Assessment Results of Diagnostic or Laboratory Tests

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Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention Immunization Healthy lifestyle practices Adequacy of rest and sleep, exercise and use of protective measures Use of promotive-preventive health services

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Typology of Nursing Problems

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FIRST LEVEL ASSESSMENT 1.Wellness Condition Wellness Potential A nursing judgment on wellness state or condition based on clients performance, current competencies or clinical data BUT NO explicit expression of client desire. Readiness for Enhanced Wellness A nursing judgment on wellness state or condition based on clients performance, clinical data and explicit expression of desire to achieve a higher level of state or function in a specific area on health promotion and maintenance.

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FIRST LEVEL ASSESSMENT 2. Health Threats Family history Threat of infection Family size beyond what family can adequately provide Accident Hazards Faulty/unhealthy eating habits Stress provoking factors Poor home/environment condition Unsanitary food handling and preparation Unhealthy lifestyle and personal habits/practices

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FIRST LEVEL ASSESSMENT Health Threats Unhealthful lifestyles Physical inactivity Inadequate relaxation techniques Non-use of self protection methods Inherent personal characteristics Health history which induce the occurrence of a health deficit Inappropriate role assumption Lack of immunization

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FIRST LEVEL ASSESSMENT 3. Health Deficits Illness states Failure to thrive/develop according to normal rate Disability

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FIRST LEVEL ASSESSMENT 4. Foreseeable Crisis Situations Marriage Pregnancy Parenthood Abortion Adolescence Loss of Job Death of a member Divorce

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SECOND LEVEL ASSESMENT Inability to recognize the presence of a problem Inability to make decisions with respect to taking appropriate health action Inability to provide adequate nursing care to the sick disabled, dependent or vulnerable/ at risk member of the family Inability to provide a home environment which is conducive to health maintenance and personal development Failure to utilize community resources for health care

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Criteria in Different Priorities Nature of the Problem Presented Categorized whether a Health Threat, Health Deficit or Foreseeable Crisis Modifiability of the Problem Refers to the probability of success in minimizing alleviating or totally eradicating the problem through health intervention

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Criteria in Different Priorities Preventive Potential Refers to the nature and magnitude of the future problem that can be minimized or totally prevented if intervention is done in the problem. Salience Refers to the family perception & evaluation of the problem in terms seriousness & urgency of attention needed.

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SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES CriteriaWeight 1.Nature of the problem presented Scale: Wellness state Health Threat Health Deficit Foreseeable Crisis 1 3 2 1

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SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES CriteriaWeight 2.Modifiability of the Problem Scale: Easily modifiable Partially modifiable Not modifiable 2 1 0

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SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES CriteriaWeight 3. PreventivePotential Scale: High Moderate Low 1 3 2 1

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SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING TO PRIORITIES CriteriaWeight 4. Salience Scale: A serious problem, immediate attention A problem but not needing immediate attention Not a felt need / problem 1 2 1 0

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SCORING 1. Decide on a score for each of the criteria. 2. Divide the score by the highest possible score and multiply by the weight. Score ----------------- X Weight Highest Score 3. Sum up the scores for all the criteria. The highest score is 5, equivalent to the total weight. The higher the score (near 5 and above) of a given problem, the more likely it is taken as a PRIORITY. With the available scores, the nurse then RANKS health problems accordingly.

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Example Cues/DataFamily Nursing Problem 37 year old mother of seven at 21 weeks AOG, with BP of 140/90 and slight pedal edema Mother verbalized, I did not have problems during my previous pregnancies, and even with my present pregnancy it just happened that I passed by the health center on my way to my in- laws so I thought of dropping by the clinic but actually I feel alright, I dont think I have to worry. Possible Complicated Pregnancy Inability to recognize presence of a possible complication of pregnancy due to lack of knowledge Inability to provide adequate nursing care to a pregnant member due to lack of knowledge on the nature and management of health condition Failure to utilize community resources for health care

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Possible Pre-eclampsia CriteriaComputation Actual Score Justification Nature of the Problem 3/3 x 11 The problem is a health deficit and requires more immediate intervention Modifiability of the Problem 2/2 x 22 The resources and interventions needed to solve the problem are available Preventive Potential 3/3 x 11 Possibility of complications during labor and delivery and occurrence odabnormalities in the infant are prevented if pre-eclampsia is eliminated as early as possible Salience of the Problem 0/2 x 10 The family doesnt recognize the existence of the problem Total Score4