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