Guidelines for Family Nursing

Practice
Sequence of Activities in The Family Nursing Practice:

1. Establishes a working relationship with the client

a. initiates contact
b. communicates interest in the family’s welfare
c. expresses/shows willingness to help with
expressed need (s)
d. maintains a two-way communication with the
family

2. Conducts an initial assessment to determine the presence of any health

problems.

TOOL: Comprehensive Family Survey

3. Categorizes Health Problems into:
• Health Threats
• Health Deficits
• Foreseeable Crisis Situations or Stress Points

TOOL: Typology of Nursing Problems in Family Nursing

Practice: First Level Assessment

4. Determine the nature and extent of the family’s performance of the health
tasks on each of the health problems categorized in activity no.3;

Define family nursing problems based on:

Typology of Nursing Problems in Family Nursing
Practice: Second Level Assessment
5. Determine priorities among the list of health problems
• Considers the nature of the problem presented
• Evaluates the modifiability of the problem
• Evaluates the preventive potential of the problem
• Evaluates the family’s perception/evaluation of each
problem in terms of seriousness and urgency of attention
needed.

TOOL: Scale for Ranking Health Problems

according to Priorities
6. Ranks health problems according to priorities.

7. Decides on what problems to tackle in the order of immediacy/urgency,

based on priorities set.
8. Defines nursing objectives in realistic measurable terms jointly with the
family. S M A R T

9. Plans approaches, strategies of action (interventions), criteria and

standards for evaluation.

10. Implements the plan of care.

11. Evaluates the effectivity of implemented aspects of the plan.

12. Re-defines nursing problems and re-formulates objectives according to

evaluation findings.
First Level Assessment
-is a process whereby existing and potential
health conditions or problems of the family
are determined.

Category of Health conditions/Problems:

.Wellness state/s
.Health Threats
.Health deficits
.Stress points or foreseeable crisis situations
Refer to SAS-12
Second Level Assessment

-the nature or type of nursing problems that the

family encounters in performing the health
tasks with respect to a given health condition or
problem, and the etiology or barriers to the
family’s assumption of the tasks.

Steps in Family Nursing Assessment

 Initial Data Base for Family Nursing
Practice
A. Family Structure & Characteristics

1. Members of the household & relationships to the head of the

family

2. Demographic Data: age, sex, civil status, position in the family

3. Place of Residence of each member – whether living with the

family or elsewhere

4. Type of family structure: matriarchal, patriarchal, nuclear or

extended

5. Dominant family members in terms of decision making in matters of

health care

6. General relationship – presence of any obvious readily observable

conflict between members; characteristic communication patterns among
members
B. Socio-Economic & Cultural Factors

1. Income and Expenses

• Occupation, place of work and income of each working member
• Adequacy to meet basic necessities (food, clothing and shelter)
• Who makes decisions about the money and how is it spent?

2. Educational attainment of each member

3. Ethnic Background and Religious Affiliation

4. Significant Others – role they play in the family’s life

5. Relationship of the family to larger community – family’s

participation in the community activities
B. Socio-Economic & Cultural Factors

1. Income and Expenses

• Occupation, place of work and income of each working member
• Adequacy to meet basic necessities (food, clothing and shelter)
• Who makes decisions about the money and how is it spent?

2. Educational attainment of each member

3. Ethnic Background and Religious Affiliation

4. Significant Others – role they play in the family’s life

5. Relationship of the family to larger community – family’s

participation in the community activities
C. Environmental Factors

1. Housing
• Adequacy of living space
• Sleeping arrangement
• Adequacy of the furniture
• Presence of insects and rodents
• Presence of accident hazards
• Food storage and cooking facilities
• Water supply – source, ownership, potability
• Toilet Facility – type, ownership, sanitary condition
• Garbage/Refuse Disposal – type, sanitary condition
• Drainage System – type, sanitary condition

2. Kind of neighborhood: congested, slum, etc.

3. Social & Health facilities available

4. Communication & Transportation Facilities Available

D. Health Assessment of each member

1. Medical & Nursing history indicating past significant illnesses,

beliefs & practices conducive to illness.

2. Nutritional Assessment (specially vulnerable or at risk members)

• Anthropometric data: weight, height, mid upper arm circumference
• Dietary history indicating quality & quantity of food intake per day
• Eating/Feeding Habits/Practices

3. Current health status indicating presence of illness states

(diagnosed or undiagnosed by medical practitioner)
E. Value placed on prevention of disease

1. Immunization Status of Children

2. Use of other preventive services

 Typology of Nursing Problems in Family Nursing Practice

First Level Assessment

I. Presence of Health Threats, Health Deficits & Foreseeable Crisis

A. Health Threats – conditions conducive to disease, accident or

failure to realize one’s health potential,
Ex.
1. Health history of specific disease/condition
(like family history of diabetes)

2. Threat of cross infection from a communicable disease case

3. Family size beyond what family resources can adequately provide

4. Accident hazards – ex. broken stairs, fire & fall hazards, pointed/
sharp objects, poisons & medicines improperly kept
5. Nutritional
• Inadequate food intake both in quantity & in quality
• Excessive intake of certain nutrients
• Faulty eating habits

6. Stress provoking factor

• Strained marital relationship
• Strained parent-sibling relationship
• Interpersonal conflicts between family members

7. Poor environmental sanitation

• Inadequate personal belongings/utensils
• Lack of food storage facilities
• Polluted water supply
• Unsanitary waste disposal
• Improper drainage system
8. Unsanitary food handling & preparation

9. Personal habits/practices
• Frequent drinking of alcohol
• Excessive smoking…………………….
• Walking barefoot
• Poor personal hygiene
• Self medication

10. Inherent personal characteristics

(like short temper)

11. Health history which precipitate/induce the occurrence of a

health deficit
ex. previous history of difficult labor
12. Inappropriate role assumption
ex. Child assuming mother’s role

13. Lack of immunization / inadequate immunization

status of children

14. Family disunity

• Self-oriented behavior of members
• Unresolved conflicts of members
• Intolerable disagreements
B. Health Deficit – instances of failure in health maintenance

1. Illness states, regardless whether it is diagnosed or

undiagnosed by medical practitioner

2. Failure to thrive/develop according to normal rate

3. Disability arising from illness, whether

transient/temporary
Ex. Aphasia or temporary paralysis from a CVA,
blindness from measles,
lameness from polio,
leg amputation secondary to diabetes
C. Stress Points / Foreseeable Crisis Situations –
anticipates periods of unusual demand on the individual or
family in terms of adjustments/family resources

Ex. 1. Marriage
2. Pregnancy, Labor, Puerperium
3. Parenthood
4. Additional member (newborn, lodger)
5. Abortion
6. Entrance at School
7. Adolescence
8. Loss of Job
9. Death of a member
10. Resettlement in a new community
11. Illegitimacy
 Criteria
Scale for Ranking in Different
Health Problems
according toPriorities
Priorities

1. Nature of the Problem Presented

• Categorized whether a Health Threat, Health Deficit or Foreseeable
Crisis

2. Modifiability of the Problem

• Refers to the probability of success in minimizing alleviating or
totally eradicating the problem through health intervention

Factors:
– Current knowledge, technology and interventions to manage the
problem
– Resources of the family (physical, financial, manpower)
– Resources of the nurse (knowledge, skills, time)
– Resources of the community (facilities & community organization)
3. 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.

Factors:
• Gravity and severity of the problem
• Duration of the problem
• Current management
• Expose of any high risk group

4. Salience
– Refers to the family perception & evaluation of the problem in terms
seriousness & urgency of attention needed.

– To determine the score for Salience, the nurse evaluates the family’s
perception of a problem. As a general rule, the family’s concerns and
felt needs require priority attention
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.

4. The higher the score (near 5 and above) of a given problem, the more
likely it is taken as a PRIORITY.

5. With the available scores, the nurse then RANKS health problems
accordingly.
SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING
TO PRIORITIES

Criteria Weight

1. Nature of the problem presented

Scale: 1
Health Threat……………. 2
Health Deficit……………. 3
Foreseeable Crisis……… 1

2. Modifiability of the Problem

Scale: 2
Easily modifiable………... 2
Partially modifiable……… 1
Not modifiable…………… 0
Criteria Weight

3. Prevention Potential
Scale: 1
High…………………….. 3
Moderate………………. 2
Low…………………….. 1

4. Salience
Scale: 1
A serious problem,
immediate attention………. 2
A problem but not needing
immediate attention………. 1
Not a felt need / problem….. 0
Examples of computation

1. Intestinal infestation/parasitism
(PRIORITY)
Criteria
1. Nature of the problem
Health Deficit 3/3 x 1 1

2. Modifiability of the problem

Partially modifiable ½x2 1

3. Preventive Potential
Moderate 2/3 x 1 2/3

4. Salience
A serious problem, immediate
attention 2/2 x 1 1

Total 3 2/3
 2. Inadequate
nutrition
Criteria
1. Nature of the problem
Health Threat 2/3 x 1 2/3

2. Modifiability of the problem

Partially modifiable ½x2 1

3. Preventive Potential
Low 1/3 x 1 1/3

4. Salience
A serious problem,
immediate attention 2/2 x 1 1

Total 3
 3. Poor environmental
sanitation
Criteria

1. Nature of the problem

Health Threat 2/3 x 1 2/3

2. Modifiability of the problem

Partially modifiable ½x2 1

3. Preventive Potential
Low 1/3 x 1 1/3

4. Salience
A problem but not needing
immediate attention. ½x1 ½

Total 2½
II. Inability to recognize the presence of a problem due to:

1. Ignorance of facts

2. Fear of consequences of diagnosis of problem

• Social stigma, loss of respect of peer/significant others
• Economic - cost
• Physical / Psychological

3. Attitude / Philosophy in life

III. Inability to make decisions with respect to taking appropriate health
action due to:

1. Failure to comprehend the nature, magnitude / scope of the problem

2. Low Salience of the problem

3. Feeling of confusion and/or resignation brought about by failure to

breakdown problems into manageable units of attack

4. Lack of knowledge / insight as to the alternative courses of action

open to them

5. Inability to decide which action to take from among a list of

alternatives

6. Conflicting opinions among family members / significant others

regarding action to take
7. Ignorance of community resources for care

8. Fear of consequences of action

• Social
• Economic
• Physical / Psychological

9. Negative attitude towards the problem – by negative attitude

is meant one that interfere with rational decision making

10. Inaccessibility of appropriate resources of care

• Physical – location
• Cost

11. Lack of trust / confidence in the health personnel / agency

12. Misconceptions or erroneous information about proposed course (s)

of action

The view of metro Manila from the northwest.

IV. Inability to provide adequate nursing care to the sick disabled,
dependent or vulnerable/ at risk member of the family due to:

1. Ignorance of facts about the disease/ health condition (nature,

severity, complications, prognosis and management); child
development & child care

2. Ignorance of the nature & extent of nursing care needed

3. Lack of the necessary facilities (equipment & supplies) for care

4. Lack of knowledge & skill in carrying out the necessary treatment/

procedure/ care
5. Inadequate family resources for care
• Responsible member
• Financial
• Physical resources – isolation room

6. Negative attitude towards the sick, disabled,

dependent, vulnerable / at risk member

7. Attitude / philosophy in life

8. Members preoccupation with own concerns /

interests
V. Inability to provide a home environment which is conducive to
health maintenance and personal development due to:

1. Inadequate family resources

• Family
• Physical (lack of space to construct facility)

2. Failure to see benefits (specifically long term ones) of investment

in home environment improvement

3. Ignorance of importance of hygiene and sanitation

4. Ignorance of preventive measures

5. Lack of skill in carrying out measures to improve home

environment

6. Ineffective communication patterns

7. Attitude / philosophy in life

VI. Failure to utilize community resources for health
care due to:

1. Ignorance or lack of awareness of community resources for

health care.

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

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

4. Previous unpleasant experience with health worker

5. Fear of consequences of action (preventive, diagnostic,

therapeutic, rehabilitative)
• Physical / Psychological
• Financial
• Social (ex. loss of esteem of peer / significant others)
6. Unavailability of required care / service

7. Inaccessibility of required care / service

• Cost
• Physical location

8. Lack of inadequate family resources

• Manpower
• Financial (cost of medicine prescribed)

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

(ex. mental illness)

10. Attitude / philosophy in life

- Is the set of actions the nurse decides to implement to be
able to resolve identified family health and nursing problems.

1. focuses on actions (designed to solve or alleviate

existing problems)….The PLAN is a Blueprint for action.
2. product of deliberate systematic process
[Link] process
1. Clear definition of problem
2. Consistent with the goals & philosophy of the health agency
3. Realistic
4. It is drawn with the family…
nurse works with the family not for the family
5. Be kept in written form

- Provides individualized care

- Helps in setting priorities
- Promotes systematic communication
- Continuity of care
- Facilitate coordination of care
Action-Setting

RESOURCES FOR ACTION

• MATERIALS
– Supplies, equipments, teaching kit, visual aids,
hand-outs
• MANPOWER
– The Health Team, Gov. Employees,
Community Leaders, Social Worker, Volunteer
Groups, Non-Government Organizations
• MACHINE
- Medical equipments and instruments,
Computers, Electronic/Industrial devices
FAMILY NURSING CARE PLAN