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

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

3. 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 family’s 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

4. Initial Data Base for Family Nursing Practice

5. 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

6. 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

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

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

9. 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

10. Typology of Nursing Problems

11. FIRST LEVEL ASSESSMENT
1.Wellness Condition
Wellness Potential
A nursing judgment on wellness state or condition based on client’s 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 client’s 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.

12. 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

13. 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

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

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

16. 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

17. 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

18. 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.

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

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

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

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

23. 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.

24. Example Cues/Data Family 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 don’t 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

25. Possible Pre-eclampsia
Criteria
Computation
Actual Score
Justification
Nature of the Problem
3/3 x 1 1
The problem is a health deficit and requires more immediate intervention
Modifiability of the Problem
2/2 x 2 2
The resources and interventions needed to solve the problem are available
Preventive Potential
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 1
The family doesn’t recognize the existence of the problem
Total Score 4