Community Health

Nursing: The Family

Nursing Process
Professor: Klyne Ken T.
Cabag, RN
 A. Assessment in Family
Health Nursing Practice
• a.) Family perspective in community health nursing
practice
• Community health nurses in many parts of the world
have been using the family perspective to address
individual client’s health needs or problems and enhance
family functioning for growth and development, coping
with illness or loss, mobilizing resources and maintaining
an environment that support wellness and health.
 A. Assessment in Family
Health Nursing Practice
• a.) Family perspective in community health
nursing practice
• Even in the western world, like the USA, where managed
care system is the structure for patient care delivery (such
as health maintenance organizations and independent
practice association) renewed focus on the family is
emerging as institution-based health care is significantly
decreasing and home care is rapidly growing.
 A. Assessment in Family
Health Nursing Practice
• a.) Family perspective in community health
nursing practice
• There are several reasons for focusing on the family in
community health nursing practice, based on its characteristic
as an open and developing system of interacting personalities,
with a structure and process enacted in relationships among
individual members, regulated by resources and stressors, and
existing within the larger community.
 A. Assessment in Family
Health Nursing Practice
• b.) Family nursing practice: Theoretical Perspectives
• Family Nursing practice emphasizes the need to
understand the behavior of the family as a dynamic,
functioning unit which affects its capability to help
itself and maintain system integrity, or its readiness
to work with the nurse in enhancing wellness or
addressing problems on health and illness.
 A. Assessment in Family
Health Nursing Practice
• b.) Family nursing practice: Theoretical
Perspectives
• Theoretical frameworks provide directions by
which the nurse can organize observations, focus
inquiries, design the application of the nursing
process in family nursing practice and
communicate realities and outcomes of care.
 A. Assessment in Family
Health Nursing Practice
• The family systems theory
• The interactional approach or Symbolic
Approach
• The Developmental approach
• Structural-functional Perspectives
 Functional Processes
• 1. Caregiving
• 2. Cathexis-emotional bonds between individuals
and family
• 3. Celebration-tangible forms of shared meanings
• 4. Change-dynamic nonlinear process implying
altering or modifying the form, direction, and
outcome thru alternatives
 Functional Processes
• 5. Communication-primary ways to socialize children about
health beliefs, values, attitudes and behaviors and use
information, knowledge and actions applicable to health
• 6. Connectedness-ways the family as a system are linked
together
• 7. Coordination-cooperative sharing of resources, skills,
abilities, and information within the family and with the larger
contextual environment to optimize individual’s health
potentials, potentiate the household production of health and
achieve family goals.
 The Family Health Tasks
Perspectives
• These are examples of major
theoretical perspectives which
describe, explain, and predict family
behavior to understanding the family
as a functioning unit and as a client
partner
 The Family Health Tasks
Perspectives
• It provides a systematic guide for the nurse to
identify what assessment data are needed and
how to generate, sort out, organize and analyze
large amount of disparate data about the
family. The unique behavior of a family as a
functioning unit explains the realities and
degree of openness to change as client and
partner of the nurse in family nursing practice
 The Family Health Tasks
Perspectives
• Theoretical frameworks which explain and predict this
unique behavior of the family provide directions on how
the nurse can work with the family as a functioning unit
and client partner by enhancing its system effectiveness
in sustaining resource/energy availability and use for
system change and facilitating boundary efficiency in
allocating access to external support or use of
information to promote wellness, enhance growth and
development, create an environment for a healthy
lifestyle, or manage health or related problems.
 The Family Health Tasks
Perspectives
• Respect for family values and readiness to
understand and maximize use of family rules,
norms, and family attitudes as components of
boundaries and filtering mechanisms are
essential in creating efficient, semipermeable
family system boundaries through a working
relationship based on trust and guided by clear
and mutually established goals and
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational Framework
• Nursing Assessment is the first major phase in the
assessment process. In family health nursing practice,
this involves a set of actions by which the nurse
determines the status of the family as a client, its
ability to maintain itself as system and functioning
unit, and its ability to maintain wellness, prevent,
control or resolve problems in order to achieve health
and well-being among its members
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational Framework
• Data about the present condition or status of
the family are gathered and analyzed based on
how family dynamics, realities, possibilities and
vulnerabilities generate the antecedents or
factors associated with health and illness
experiences.
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational Framework
• Utilizing the theoretical models to understand the
characteristics and behavior of the family as a
functioning unit and client, the operational framework
for assessment focuses on types of assessment data
to generate method and tools to collect these data,
and finally, application of the family health tasks
perspective in determining family health nursing
problems associated with specific health conditions or
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational
Framework
• Nursing assessment includes:
• data collection,
• data analysis or interpretation and problem
definition or nursing diagnosis
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational
Framework
• Nursing diagnosis is the end result of two major
types of nursing assessment in family nursing
practice based on the framework.
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational
Framework
• Continuation.. These are:
• 1. First level assessment
• 2. Second level assessment
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational Framework
• 1. First level assessment is a process whereby
data about the current health status of
individual members of the family as a system
and its environment are compared against the
norms or standards of personal, social, and
environmental health and interactions/
interpersonal relationships within the family
 A. Assessment in Family
Health Nursing Practice
• c.) Nursing Assessment: Operational Framework
• As end result of data analysis during the first level assessment,
specific health conditions or problems are identified and
categorized as
• 1. Wellness state/s
• 2. Health threats
• 3. Health deficits
• 4. Foreseeable crisis or stress points
 A. Assessment in Family
Health Nursing Practice
• 2. Second level assessment specifies the
nursing problems that the family
encounters in performing the health tasks
with respect to a given health condition or
problem, and the causes, barriers or
etiology of the family’s ability to perform
the health task
 A. Assessment in Family
Health Nursing Practice
• 2. Second level assessment
• The two levels of assessment specify a
hierarchy of two sets of data and their
analyses. They reflect the depth of data
gathering and analysis on what health
conditions or problems exist which is termed as
first level assessment, and why each health
condition or problem related with maintaining
 A. Assessment in Family
Health Nursing Practice
• 2. Second level assessment
• The latter is stated as explanation about the
family’s problem related to maintaining
health/wellness, managing health
problems/illness experience or providing a
home environment conducive to health
maintenance and personal development
termed as the second level assessment.
 A. Assessment in Family
Health Nursing Practice
• d.) Steps in Family Nursing Assessment
• There are three major steps in Nursing
Assessment as applied to family nursing
practice:
• 1. Data collection
• 2. Data analysis
• 3. Formulation of Diagnosis
 A. Assessment in Family
Health Nursing Practice
• d.) Steps in Family Nursing Assessment
• Data collection for first level assessment involves
gathering of five types of data which generates the
categories of health conditions or problems of the
family. These include: 1. Family structure,
characteristics and dynamics 2. Socio-economic and
cultural characteristics 3. Home and environment 4.
Health status of each member 5. Values and practices
on health promotion/maintenance and disease
 A. Assessment in Family
Health Nursing Practice
• d.) Steps in Family Nursing Assessment
• Second level assessment data include those
that specify or describe the family’s realities,
perceptions, and attitudes related to the
assumption or performance of the family health
tasks on each health condition or problem
identified during the first level assessment
 Data analysis involves several
sub-steps
• 1. Sorting of data for broad categories such as those
related to the health status or practices of the family
members or data about home and environment
• 2. Clustering of related cues to determine relationships
between and among data
• 3. Distinguishing relevant from irrelevant data to decide
what information is pertinent to understanding the
situation at hand based on specific categories or
dimensions
 Data analysis involves several
sub-steps
• 4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication or interaction
patterns and lifestyle
• 5. Relating family data to relevant clinical/research findings and comparing
patterns with norms or standards of health such as nutritional intake,
immunization status, growth and development, social and economic
productivity and environment health requisites. It also includes the family
functioning and assumption of health tasks
• 6. Interpreting results based on how family characteristics, values, attitudes,
perceptions, lifestyle, communication, interaction, decision- making, or
role/task performance are associated with specific health conditions or
problems identified
 Data analysis involves several
sub-steps
• 7. Making inferences or drawing
conclusions about the reasons for the
existence of the health condition or
problem and risk factor/s related to non-
maintenance of wellness state/s which can
be attributed to non-performance of
family health tasks
 The last step in family nursing
assessment involves
making a diagnosis. This include two (2)
types:
• 1. Definition of wellness state or potential or health
• condition or problems as an end-product of the first
level assessment
• 2. Definition of the family nursing problems as an
end-result of the second level assessment. The
family nursing problem is stated as inability to
perform a specific health task and the reason or
etiology why the family cannot perform such task.
 Data gathering Methods
and Tools
• 1. Observation: is done through the use of the sensory
capacities
• 2. Physical assessment: significant data about the health
status of individual family members Inspection; palpation;
percussion; auscultation
• 3. Interview: Completing a health history of the family. Asking
personally significant family members or relatives regarding
health condition or problems
• 4. Record review: the nurse gathers information through
reviewing existing records and reports pertinent to the client
 Data gathering Methods
and Tools
• 5. Laboratory/Diagnostic Tests:
data collection through performing
laboratory test, diagnostic
procedures, or other tests of
integrity and functions carried out
by the nurse herself