Family Nursing Process: Assessment

Family Nursing Process

• The family nursing process is a systematic approach that strengthens a family's ability to meet health needs and solve health problems.

Nursing Assessment

• Nursing assessment is the initial phase of the nursing process.
• Involves measuring the status of the family unit
• Measures the status of the family as a client.
• Measures the ability of the family to maintain itself as a functional and system.
• Measures the ability of the family to prevent, control, or resolve health issues to improve its member's health.

Components of Nursing Assessment

• Data collection
• Data Analysis and Interpretation
• Definition of problems and Nursing Diagnosis

Types of Nursing Assessment

• First level assessment categorizes existing and potential problems into wellness states, health threats, health deficits, stress points, or foreseeable crises.
• Second level assessment defines the nature/type of nursing problems that a family faces while performing health tasks with respect to health conditions and/or problems.

Steps in Family Nursing Assessment

• Data collection is gathered.
• Data analyzed
• Health conditions and nursing diagnoses determined

Data Collection

• First level assessment involves categorizing potential problems such as wellness statuses, health threats and deficits, stress points and future crises.
• Second level assessment involves identifying nursing problems by nature.

First Level Data

• Five types of data are gathered:
  • Family structure, characteristics, and dynamics.
  • Socioeconomic and cultural characteristics.
  • Home and environment.
  • Health status of each member.
  • Health promotion/maintenance and disease prevention values and practices.
• Data gathering methods include observation, physical examination (PE), interviews, review of records and lab/diagnostic procedures.

Second Level Data

• Family's assumptions on health conditions or problems are collected.
• Information about the specific health task involved is collected.
• Information on each health condition or problem.
• Family's perception on each conditions is captured.
• Decisions made, their appropriateness and reasons, if none is gathered.
• The effects of decisions and actions on other family members are collected.

Data Analysis Sub-steps

• Sort data related to health status or practices.
• Cluster/group related data
• Distinguish relevant from irrelevant data.
• Identify patterns with norms
• Compare patterns with norms or standards.
• Interpret results of comparisons.
• Make inferences or drawing conclusions

Health Problems and Nursing Diagnosis

• First Level Assessment: definition of wellness state, potential health condition, or problems as an end product.
• Second Level Assessment: definition of the family nursing problem as an end product.

Types of Data in Family Nursing Assessment

• There are two types of data used in family nursing practice:
  • Initial data base gathered during the first level assessment.
  • Data gathered during the second-level assessment reflects the degree to which families can perform health tasks on existing health conditions/problems.
• The initial database include:
  • Structure of the family
  • Socioeconomic and cultural conditions
  • The family's home and general environment.
  • Health status of all family members.
  • Values and practices that promote health, maintain health, and try to prevent disease.
• The data includes:
  • The family's perception of a give problem
  • The decisions that the family has made and how appropiate it was
  • The actions of the family and the direct results from such
  • The direct effects that the decisions an actions taken have on the health of family memebrs

Data-gathering Methods/Tools

• Observation is a method that includes using sensory capacities to gather information about a family's well-being.
• Communication, interaction patterns, interpersonal relationships, role perception, decisions, home & environmental conditions can all be assessed through observation.
• Physical examinations and interviews involve completing histories with family, asking significant members, and gathering information from colleagues.
• Reviewing records and reports is a part of the Records review.
• Lab/diagnostic tests

Second Level Assessment Procedures

• Toadequately address each health or crisis state, determine if the family recognizes the problem or condition.
• If family recognizes the issue, determine if something has been done to resolve the problem.
• Find out if the family is encountering more problems in addressing the issue.
• Determine how the problem is affecting other family members.

Data analysis

• Data analysis utilizing tools on the initial data base in family nursing practice. Sorts out, classifies, or group data by type of nature. Relates data with each other.
• Determines patterns and recurring themes among the data. Compares data with norms or standards.

The Initial Data Base data includes:

• Family structure, characteristics, and dynamics
• Socio-economic and cultural characteristics
• Home and environment
• Health status of each family member
• Promotion and maintenance to the family's health

Standards and Norms

• Standards and norms utilized in determining family health status:
  • Normal health of individual members.
  • Home & environmental conditions conducive to development.
  • Family traits/dynamics or functioning conducive to development.

Characteristics of Healthy Family Functioning

• Flexible role patterns
• Responsiveness to individual member's needs
• Dynamic problem solving
• Ability to accept help
• Open communication
• Experience of trust/respect in caring environment
• Capacity to build constructive relationships

Standards of Functioning Family

• Functioning families can:
  • Recognize health conditions/problems.
  • Make decisions for health action.
  • Provide nursing care.
  • Maintain a healthful home.
  • Use community resources.

End Results of First Level Assessment Analysis

• The end result of data analysis during the first-level assessment is a conclusion:
  • Definition of a wellness state
  • A health condition or problem classified as a wellness potential, health threat, health deficit, or stress point/foreseeable crisis.
  • The result is medical or Nursing Diagnosis indicating current health status of family member.
  • Determination of home/environmental conditions.
  • Determination of a developmental, maturation, or situational crisis.

Nursing Diagnosis

• The Nursing Diagnosis may be formulated at:
  • Single-family member, family unit or family relation to its community levels.
• The North American Nursing Association (NANDA) gives a framework on how to response toward the human body towards potential or actual problems.
• Another alternative way to provide diagnostic information is with the use of a Family Coping Index

Family Coping Index

• Helps estimate the nursing that a family may require
• Healthcare is deemed necessary among families once
  • There is a health problem that a family can not solve or deal with
  • It's likely that the nursing will make a difference

Family Coping Index (Scaling)

• Consists of two parts:
  • The point on a scale
• A statement for the justification

A point on the scale

• Allows nurses to view a family and how it handles nursing actions at any time.

Key considerations relating to rating a point on the scale

• Capacity of the family for coping and not the problem that is being rated
• Nurse should be acquainted with data.
• The rating should consider the family and the individual.
• Ratings should be completed after 2-3 home visits.

Scale of Competence

• 0-2 means not competent
• 3-5 means poorly competent
• 6-8 means moderately competent.
• 9 means fairly competent.
• A terminal rating indicates family progress in competence.

Scaling Cues

• 0 = no competence
• 3 = moderate competence
• 5 = complete competence

Justification statement

• Explains why you have rated the family as you have.

Behavior Factors of Observable facts

• Physical independence
• Therapeutic competence
• Knowledge of condition
• Application of hygiene
• Health, emotional & family living perspectives,
• Enviroment
• Community support

Physical Independence for Assessment

• The movement about of the patient
• The ability of the patient to take care of themselves.

Theraeutic Competence for Assessment

• Is the ability to provided treatment that has been prescribed
• Is the administering of medication and relaxation

Knowledge of health condition

• Is knowing what sort of care that the condition needs to be maintained.

Application of Hygiene

• Family action in maintaining nutrition.
• Securing relaxation and adequate rest.

Data analysis in Family Nursing

• Includes general information.
  • Family name and address
• Family structure
• Family lifestyle
  • Dietary and exercise habits.
  • Cultural practices
• Socio-economic factors
  • Religion and income
• Health and Medical History
  • Illnesses and past conditions
• Environmental factors
  • Housing and transportation

First Level Assessment

• Presence of wellness state or condition of people.
  • Potential for enhanced condition.
  • Readiness for enhanced function.
• Health threats
• Health deficit
• Stress point/foreseeable crisis

Wellness Condition

• is a clinical judgement regarding the clients movement form one state to another.

Health Threats

• Conditions that promote disease and failure.
  • Family history of medical problems and conditions
  • Inadequate education
  • A large family

Health Deficits

• Instances of failure in health maintenance (disease, disability, development lag)
• Includes Illnesses, and personality dissorders

Stress points/Foreseeable crisis situation

• Refers to the unusual demands placed in a family
• Includes pregnancy, labor, abortion, and miscarriage

Second Level Assessment

• The problems nurses experience in performing specific health task.

Five Main Health Task

• Recognizing the presence of a problem
• Failing to make decisions or provide adequate care
• Failing to use the various resources

Assessment and Diagnose

• In second level assessment, Dr. Maglaya built on Freeman's health task when developing the Typology of Nursing Problems.
• Therefore the nurse mostly deals with problems in the human domain.

Nursing diagnosis

• Includes information for the patients wellness, failure to keep good health,,
• Failure for the family to keep a specific health task.

Planning, Implementing and Evaluating

• The nurse should prioritize which problems need the most attention depending on the resources of the family.
• Four criteria in prioritizing health conditions:
  • The nature of the problem
  • Wellness
  • Health Deficit
  • Health Threat

Priority Setting: Modifiability

• Refers to the chance of getting to wellness
• Resources from:
  • Knowledge
  • Family
  • Nurses
  • Community

Priority Setting

• Depends on
  • Gravity of the problem -Current management -Duration of time

Priority Setting: Salience

• Refers to the the patients evaluation of the information

Scales

• Used for ranking health problems

Scoring

• Divide by the weight score.

The Planning phase

• Analysis of the Health problem
• Establishing how important it is
• Setting goals
• Formulating a heath care plan

Examples

• Health threats in a family may require assessment,
• Which will follow with the use of a second level assessment for nursing tasks.