Family Health Nursing Practice 1

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    Nursing Assessment in Family

    Health Practice

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    Family Health Nursing Practice

    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.

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    Family Nurse Practitioner

    Meets the health care needs of the family

    by providing health assessments, direct

    care, and guidance, teaching orcounseling as appropriate, particularly

    around family self care.

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    Levels of Nursing assessment

    First level Assessment Data gathering and analysis on what health

    conditions or problems exist and why it exists

    Second level Assessment Explanations about the familys problems

    related to maintaining wellness and/or provide

    a home environment conducive to health

    maintenance and personal development.

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    Primary Assessment

    Is a process where existing and potential healthconditions or problems of the family aredetermined.

    Four Categories: Wellness state,

    Health threats,

    Health deficits,

    Stress points or foreseeable crisis situations

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    Wellness State Wellness is generally used to mean a healthy balance of the

    mind, body and spirit that results in an overall feeling ofwell-being.

    Wellness is a view of health that emphasizes the state of the

    entire being and its ongoing development.

    Determinants of wellness: better understanding of concepts like destiny,

    health practices,

    spirituality,

    family,

    environment,

    work, money and security,

    health services,

    social support and leisure.

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    Health Threats

    Conditions that are conducive to disease andaccident, or may result to failure to maintain

    wellness or realize health potential

    Risk factors of specific disease

    Family size beyond family resources

    Accident hazards

    Unhealthy nutritional/eating habits or feeding techniques practices

    Stress-provoking factors

    Poor environmental condition/sanitation Unsanitary food handling & preparation

    Lack/Inadequate immunization

    Family disunity

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    Health Deficits

    Instances of failure in health maintenance

    Illness states

    Failure to thrive/develop

    Disability

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    Stress Points/Foreseeable Crisis

    Anticipated periods of unusual demand onthe individual or family in terms of

    adjustment, family or resources Marriage

    Pregnancy

    Parenthood

    Additional member\

    Divorce or separation

    Loss of jobs

    Hospitalizations

    Death of a member

    Adolescence

    School entrance

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    Second-Level Assessment

    The nature or type of nursing problems

    that the family encounters in performing

    the health tasks with respect to a givenhealth condition or problem, and the

    etiology or barriers to the familys

    assumption of these tasks.

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    1. Determine if the family recognizes the existence of the condition or

    problem. If the family does not recognize the presence of the conditionor problem, explore the reason why.

    2. 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.

    3. Determine if the family encounter other problems in implementing the

    interventions for the wellness state/potential, health threat, health

    deficit or crisis.4. Determine how all the other members are affected by the wellness

    state/potential, health threat, health deficit or stress point.

    Second-Level Assessment

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    STEPS IN FAMILY NURSING

    ASSESSMENT

    Data Collection

    Data Analysis/ Interpretation

    Diagnosis/Problem definition

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    Types of data which will generate the

    categories of health problem

    1 . Family structure, characteristics and

    dynamics;

    2. Socio-economic and cultural characteristics;

    3. Home and environment;

    4. Health status of each member; and

    5. Values and practices on health

    promotion/maintenance and diseaseprevention

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    Family Structure, Characteristic & Dynamics

    1. Members of the family and relationship to the head

    2. Demographic data-age, sex, civil status, position

    3. Place of residence of each member

    4. Type of family structure e.g. nuclear/extended

    5. Dominant family member in decision making

    6. General family relationship/dynamics

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    Socio-economic and Cultural Characteristics

    1. Income and expenses

    a. Occupation, work place & income of working memberb. Adequacy to meet basic necessities

    c. Who makes decisions about money and how it is spent

    2. Educational attainment of each member

    3. Ethnic background and religious affiliation

    4. Significant othersrole they play in familys life

    5. Relationship of family to larger community

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    Home and Environment

    1. Housinga. Adequacy of living space / Sleeping arrangement

    b. Presence of breeding sites of vectors & diseases

    c. Presence of accident hazards

    d. Food storage and cooking facilities

    e. Water supply source , ownership, potability

    f. Toilet facility type, ownership, sanitary condition

    g. Garbage disposal type, sanitary condition

    h. Drainage system type, sanitary condition

    2. Kind of neighborhood e.g. congested, slum, etc

    3. Social and health facilities available

    4. Communication and transportation facilities available

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    Health Status of Each Family Member

    1. Medical and nursing history current or past illnesses

    2. Nutritional assessment

    a. Anthropometric data weight, height, body mass index

    b. Dietary history specifying quality/quantity of food intake per day

    c. Eating / Feeding habits and practices

    3. Developmental assessment of infants, toddlers andpreschoolers (MMDST)

    4. Risk factor assessment predisposing and contributing factors

    5. Physical assessment indicating presence of illness state/s

    6. Results of laboratory/diagnostic and other screeningprocedures

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    Values, Habits, Practices on Health

    1. Immunization status of family members

    2. Healthy lifestyle practices

    3. Adequacy of:a. Rest and sleep

    b. Exercise and activity

    c. Use of protective measures

    d. Relaxation & other stress managementactivities

    4. Use of promotive-preventive health services

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    Data Analysis

    1.Sort data

    2. Cluster/Group Related Data

    3. Distinguish relevant from Irrelevant Data

    4. Identify Patterns

    5. Compare patterns with Norms or Standards

    6. Interpret Results

    7. Make Inferences/Draw Conclusions

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    Classification of Standards/Norms

    1.Normal health of individual members

    2. Home and environmental conditionsconducive to health development, and

    3.Family characteristics, dynamics or level

    of functioning conducive to familydevelopment

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    Standards/Norms of a Functioning

    Family Unit

    1. Recognize the presence of a wellness state or healthcondition or problem

    2. Make decisions about taking appropriate healthaction to maintain wellness or manage the healthproblem

    3. Provide nursing care to the sick, disabled,dependent or at-risk members

    4. Maintain a home environment conducive to health

    maintenance and personal development5. Utilize community resources for health care

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    Family Characteristics

    Constitutes the clients ability as a system to

    maintain its integrity and achieve its purpose

    through a dynamic interchange among its

    members while responding totheexternalmulti-environments along a time continuum.

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    Characteristics of healthy family

    functioning:

    Flexible role patterns

    Responsiveness to needs of individual members

    Dynamic problem mechanism

    Ability to accept help

    Open communication patterns

    Experience of trust and respect in a warm and caringatmosphere

    Capacity to maintain and create constructiverelationships with the broader neighborhood andcommunity.

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    Nursing Diagnoses: Family Nursing

    Problems

    A wellness state or health condition becomes

    a nursing problem when it is stated as: the

    familys failure to perform adequately

    specific health tasks to enhance the

    wellness state or manage the healthproblems.

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    Typology Of Nursing Problems In

    Family Nursing PracticeFIRST-LEVEL ASSESSMENT

    1. Presence of Wellness Condition-( stated as

    potential or readiness) a clinical or nursing

    judgment about a client in transition from a

    specific level of wellness or capability to a

    higher level(NANDA,2001)

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    Wellness Potential

    Is a nursing judgment on wellness state or

    condition based on clients performance,

    current competencies or clinical data but no

    explicit expression of client desire.

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    Readiness for Enhanced Wellness

    A nursing judgment on wellness state or

    condition based on clients current

    competencies or performance, clinical data

    and explicit expression of desire to achieve ahigher level of state or function

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    A. Potential for Enhanced Capability

    for:

    1. Healthy Lifestyle

    2. Health Maintenance/Health Management

    3. Parenting4. Breastfeeding

    5. Spiritual Well-being

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    B. Readiness for Enhanced Capability

    For:

    1. Healthy Lifestyle

    2. Health maintenance/Health management

    3. Parenting4. Breastfeeding

    5. Spiritual Well-Being

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    II. Presence of Health threats

    A conditions that are conducive to disease and

    accident, or may result to failure to maintain

    wellness or realize health potential.

    Examples:

    a. Presence of risk factors of specific diseases

    b. Threat of cross infection

    c. Family size beyond what family resourcesd. Accident hazards

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    E. Faulty/Unhealthful nutritional/eating

    habits or Feeding techniques practicesF. Stress-provoking factors

    G. Poor home/Environmental

    Condition/SanitationH. Unsanitary food handling and

    preparation

    I. Unhealthful lifestyle and personalhabits/Practices

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    J. Inherent personal characteristics

    k. Health history

    L. Inappropriate role assumption

    M. Lack of ImmunizationN. Family Disunity

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    III. Presence of health Deficits

    Instances of failure in health

    maintenance.

    Examples:

    Illness states

    Failure to thrive/develop according tonormal rate

    Disability

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    IV. Presence of Stress

    Points/Foreseeable Crisis

    Anticipated periods of unusual demand on theindividual or family in terms of adjustment

    resources.

    Ex.

    a. Marriage

    b. Pregnancyc. Parenthood

    d. Additional member

    e. abortion

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    f. Entrance at school

    g. Adolescenceh. Divorce or separation

    I. Menopause

    j. Loss of jobk. Hospitalization of a family member

    l. Death of a member

    m. Illegitimacy

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    Second-Level Assessment

    I. Inability to recognize the presence of thecondition or problem due to:

    A. Lack of or inadequate knowledge

    B. Denial about its existence or severity as a resultof fear of consequences of diagnosis of problem,

    1. Social stigma, Loss of respect of peer

    2. economic/cost implications

    3. Physical consequences

    4. Emotional/psychological issues/concerns

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    II. Inability to make decisions with respect to taking

    appropriate health action due to:A. Failure to comprehend the nature/magnitude of the problem/condition

    B. Feeling of confusion, helplessness and resignation brought about by

    perceived magnitude/severity of the situation

    C. Lack of/Inadequate knowledge/insight as to alternative courses of action

    open to them

    D. Inability to decide which action to take from among list of alternativesE. Conflicting opinions among family members regarding action to take

    F. Lack of/Inadequate knowledge of community resources of care

    G. Fear of consequences of action

    H. Negative attitude toward the health condition

    I. Inaccessibility of appropriate resources for care

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    III. Inability to provide adequate nursing

    care to the sick, disabled, dependent or

    vulnerable/ at risk member of the familydue to:

    A. lack of inadequate knowledge about the

    disease/ health condition

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    B. Lack of knowledge about child development

    C. Lack of knowledge of the nature and extent ofnursing care needed.

    D. Lack of facilities

    E. Altered role performance

    Role denial

    Role strain

    Role dissatisfaction

    Role conflict

    Role confusion

    Role overload

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    III. Inability to provide a home environment conducive to healthmaintenance and personal development due to :

    A. Lack of knowledge of importance of hygiene and sanitation

    B. Lack of supportive relationship among family members

    C. Inadequate family resources

    D. Lack of/Inadequate knowledge of importance of hygiene andsanitation

    E. Lack of skill in carrying out measures to improve home envtF. Ineffective communication patterns within the family

    G. Lack of supportive relationship among family members

    H. Negative attitude/philosophy in life which is not conducive tohealth maintenance and personal development.

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    IV. Failure to utilize community resources for healthcare due to:

    A. Lack of/Inadequate knowledge of community resources forhealth care

    B. Lack of trust/confidence in the agency/personnel

    C. Failure to perceive the benefits of health care/services

    D. Previous unpleasant experience with health worker E. Unavailability of required care/service

    F. Inaccessibility of required care/service due to cost constraints orphysical inaccessibility

    G. Lack of adequate family resources

    H. Negative attitude/philosophy in life which hinders effectiveutilization of community resources for health care

    I. Feeling of alienation to/lack of support from the community

    -Recognize Need to use data based on evidence-Ensure accuracy and reliability of data

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    Ensure accuracy and reliability of data-Check for inconsistencies-Complete missing informationDATA COLLECTION

    First-level-Data onStatus condition of:Family/householdmembers

    Home and Environment

    Second Level- DataFamilys assumption

    Of health condition/Problem identified

    Methods/Sources:1st level assessmentHealth Status of theFamilyHealth assessment

    LaboratoryRecords/reports

    Home and EnvironmentObservation/OcularsurveyInterviewDx TestRecords/reportsSecond Level

    Assessment:In-Depth Interview onrealitiesPerception about andattitudesTowards performance oftaskObserve: Relate verbalwithnonverbal

    DATAANALYSIS

    -Sort data

    -Cluster/ grouprelated data

    -Distinguishrelevant fromirrelevant data

    -Identify patterns

    (e.g. function,behaviorlifestyle)

    -Comparepatterns withnorms orstandards

    -Interpret results

    -Make inferences/drawconclusions

    -First- level assessment: Define the health

    Conditions/ problems (categorized as:

    Wellness states, health deficits, health

    Threats, foreseeable crises or stress points)

    Second- level assessment: Define the family nursing

    problems/

    Diagnosis (table 3) as statements of:

    Familys inability to perform Health

    Tasks on each

    Health Condition/

    Problem specifying the barriers to

    performance

    or reasons for non- performance of

    Family Health task

    Continuous Data Validation/ Update for Adequacy ofEvidence to Support Diagnosis