Module-3-Nursing-Assessment-in-Family-Nursing-Practice.pdf

NCM 104a: COMMUNITY HEALTH NURSING (RLE) TOPIC: Nursing Assessment in Family Nursing Practice ACTIVATE PRIOR KNOWLDEGE: Define the following terms: a) Family b) Individual c) Population d) Community ACQUIRE NEW KNOWLEDGE Nursing Assessment ✓ A...

NCM 104a: COMMUNITY HEALTH NURSING (RLE) TOPIC: Nursing Assessment in Family Nursing Practice ACTIVATE PRIOR KNOWLDEGE: Define the following terms: a) Family b) Individual c) Population d) Community ACQUIRE NEW KNOWLEDGE Nursing Assessment ✓ A set of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a 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. (Maglaya 2004) ✓ It is a systematic collection of data to determine the family’s status and to identify any actual or potential health problems. (David and Rodolfo 2007) Purpose of Nursing Assessment a) Determine level of family functioning b) To clarify family interaction c) To identify family strengths and weaknesses d) To describe the health status of the family and the individual members LEVELS OF ASSESSMENT First-level assessment Second-level assessment Process whereby existing and Defines the nature or type of nursing potential health conditions or problems problems that the family encounters of the family are determined. in performing the health tasks with Reflect depth of data gathering and respect to a given health condition or analysis on what health conditions or problem, and the etiology or barriers problems exist. to the family’s assumption of these tasks. Categories of health conditions or Reflects why each health condition problems: or problem related with maintaining 1. Wellness state wellness exists. 2. Health threat These assessments are 3. Health deficit explanations about the family’s 4. Stress points or foreseeable crisis problems related to maintaining wellness and/or provide a home environment conducive to health maintenance and personal development. Goals To identify the problem of the family To determine the extent to which the family is able to perform the different health tasks NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care Steps on Family Nursing Assessment 1. Data Collection Framework: Use an organized and comprehensive approach of assessment Data taken during the First-level assessment (Initial Data base) Family 1. Members of the household and relationship to the structure, head of the family characteristics 2. Demographic data – age, sex, civil status, position in and dynamics the family 3. Place of residence of each member – whether living with the family or elsewhere 4. Type of family structure – e.g. matriarchal or patriarchal, nuclear or extended 5. Dominant family members in terms of decision-making, especially in matters of healthcare 6. General family relationship/dynamics – presence of any obvious/readily observable conflict between members; characteristic communication/interaction patterns among members Socio- 1. Income and expenses economic and 2. Educational attainment of each member Cultural 3. Ethnic background and religious affiliation Characteristics 4. Significant others – role(s) they play in family’s life 5. Relationship of the family to larger community – nature and extent of participation of the family in community activities Home and 1. Housing Environment a. Adequacy of living space b. Sleeping arrangement c. Presence of breeding or resting sites of vectors or diseases d. Presence of accident hazards e. Food storage and cooking facilities f. Water supply – source, ownership, sanitary condition g. Toilet facility – type, ownership, sanitary condition h. Garbage/refuse disposal – type, sanitary condition i. Drainage system – type, sanitary condition 2. Kind of neighborhood – e.g. congested, slum, etc. 3. Social and health facilities available 4. Communication and transportation facilities available Health status of 1. Medical and nursing history indicating current or past each family significant illnesses or beliefs and practices conductive member to health and illness 2. Nutritional assessment (specially for vulnerable or at- risk members) 3. Developmental assessment of infants, toddlers and preschoolers – e.g. Metro Manila Developmental Screening Test (MMDST) 4. Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle diseases – e.g. hypertension, physical inactivity, sedentary lifestyle, cigarette/tobacco smoking, elevated blood lipids/cholesterol, obesity, diabetes mellitus, inadequate fiber intake, stress, NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care  alcohol drinking and other substance abuse 5. Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners) 6. Results of laboratory/diagnostic and other screening procedures supportive of assessment findings Values, habits, 1. Immunization status of family members practices on 2. Healthy lifestyle practices health 3. Adequacy of: promotion, a. Rest and sleep maintenance b. Exercise/activities and disease c. Use of protective measures – e.g. adequate prevention footwear in parasite-infested areas; use of bed nets and protective clothing in malaria and filariasis-endemic areas d. Relaxation and other stress management activities 4. Use of promotive-preventive health services Second-level Assessment Reflects the extent to which the family can perform the health tasks on each health condition or problem identified. These data include: 1. The family’s perception of the problem 2. Decision made and appropriateness; if none, reasons, and 3. Actions taken and results; if none, reasons; and, 4. Effects of decisions and actions on other family members. Data Gathering Methods and Tools Observation Done through the use of the sensory capacities – sight, hearing, smell and touch. Data gathered through this method have the advantage of being subjected to validation and reliability testing by other observers. Physical examination This is done through inspection, palpation, percussion, auscultation, measurement of specific body parts and reviewing the body systems. Data generated from physical assessment form a substantive part of first-level assessment which may indicate presence of health deficits. Interview Completing a health history for each family member. Collecting data by personally asking significant family members or relatives questions regarding health, family, life experiences and home environment to generate data on what wellness condition and health problems exist in the family. Record review The nurse may gather information though reviewing existing records and reports pertinent to the client. Laboratory/Diagnostic Laboratory tests, diagnostic procedures or other tests tests of integrity are carried out by the nurse of other health workers. 2. DATA ANALYSIS a. The nurse sorts out and classifies or groups data by type or nature; relating them with each other and determines patterns or reoccurring themes among the data. These data are then compared and the patterns or recurring themes with norms or standards. b. The standard or norm of the family as a functioning unit involves the ability to perform the following health tasks: 1. Recognize the presence of a wellness state or health condition or NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care  problem. 2. Make decisions about taking appropriate health action to maintain wellness or manage the health problem. 3. Provide nursing care to the sick, disabled, dependent or at-risk members. 4. Maintain a home environment conducive to health maintenance and personal development. 5. Utilize community resources for health care. c. First-level assessment: the end result of this analysis is a conclusion – a definition of a wellness state or health condition or problem classified as a wellness state, health threat, health deficit or stress point/foreseeable crisis. d. Second-level assessment: this assessment ends with a definition of family nursing problems. 3. HEALTH CONDITIONS/PROBLEMS AND FAMILY NURSING DIAGNOSES Nursing Diagnosis – a wellness state or health condition/problem becomes a nursing problem when it is stated as the family’s failure to perform adequately specific health tasks to enhance the wellness state or manage the health problem. Nursing Diagnosis consists of two parts: 1. The statement of the unhealthful response 2. The statement of factors which are maintaining the undesirable response and preventing the desired change TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE First-level Assessment Presence of A. Potential for Enhanced Capability for: wellness B. Readiness for Enhanced Capability for: condition 1. Healthy lifestyle 2. Health maintenance/health management 3. Parenting 4. Breastfeeding 5. Spiritual well-being Presence of A. Presence of risk factors of specific diseases health threats B. Threat of cross infection from a communicable disease case C. Family size beyond what family resources can adequately provide D. Accident hazards E. Faulty/unhealthy nutritional/eating habits or feeding technique practices F. Stress-provoking factors 1. Strained marital relationship 2. Strained parent-sibling relationship 3. Interpersonal conflicts between family members 4. Caregiving burden G. Poor home/environmental condition/sanitation H. Unsanitary food handling and preparation I. Unhealthy lifestyle and personal habits/practices J. Inherent personal characteristics K. Health history which may participate/induce the occurrence of a health deficit L. Inappropriate role assumption M. Lack of immunization/inadequate immunization status N. Family disunity NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care  Presence of A. Illness states, regardless of whether it is diagnosed or health deficits undiagnosed by medical practitioner B. Failure to thrive/develop according to normal rate C. Disability Presence of stress A. Marriage points/foreseeable B. Pregnancy, labor, puerperium crisis situations C. Parenthood D. Additional member E. Abortion F. Entrance at school G. Adolescence H. Divorce or separation I. Menopause J. Loss of job K. Hospitalization of a family member L. Death of a member M. Resettlement in a new community N. Illegitimacy Second-level Assessment 1. Inability to recognize the presence of the condition or problem due to: A. Lack of or inadequate knowledge B. Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically: 1. Social stigma, loss of respect of peer/significant others 2. Economic/cost implications 3. Physical consequences 4. Emotion/psychological issues/concerns C. Attitude/philosophy in life which hinders recognition/acceptance of a problem 2. Inability to make decisions with respect to taking appropriate health action due to: A. Failure to comprehend the nature/magnitude of the problem/condition B. Low salience of the problem/condition C. Feeling of confusion, helplessness and/or resignation brought about by perceived magnitude/severity of the situation or problem D. Lack of/inadequate knowledge/insight as to alternative courses of action open to them E. Inability to decide which action to take from among a list of alternatives F. Conflicting opinions among family members/significant others regarding action to take G. Lack of/inadequate knowledge of community resources for care H. Fear of consequences of action, specifically: I. Social consequences J. Economic consequences K. Physical consequences L. Emotional/psychological consequences M. Negative attitude towards the health condition or problem N. Inaccessibility of appropriate resources for care O. Physical inaccessibility P. Cost constraints or economic/financial inaccessibility Q. Lack of trust/confidence in the health personnel/agency R. Misconceptions or erroneous information about proposed course of action 3. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family due to: A. Lack of/inadequate knowledge about the disease/health condition B. Lack of/inadequate knowledge about child development and care C. Lack of/inadequate knowledge of the nature and extent of nursing care needed D. Lack of the necessary facilities, equipment and supplies for care NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care  E. Lack of/inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure/care F. Inadequate family resources for care, specifically: 1. Absence of responsible member 2. Financial constraints 3. Limitations/lack of physical resources G. Significant person’s unexpressed feelings which disable his/her capacities to provide care H. Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at risk member I. Member’s preoccupation with own concerns/interests J. Prolonged disease or disability progression which exhausts supportive capacity of family members K. Altered role performance, specifically: 1. Role denial or ambivalence 2. Role strain 3. Role dissatisfaction 4. Role conflict 5. Role confusion 6. Role overload 4. Inability to provide a home environment conducive to health maintenance and personal development due to: A. Inadequate family resources, specifically: 1. Financial constraints/limited financial resources 2. Limited physical resources B. Failure to see benefits of investment in home environment improvement C. Lack of/inadequate knowledge of importance of hygiene and sanitation D. Lack of/inadequate knowledge of preventive measures E. Lack of skill in carrying out measures to improve home environment F. Ineffective communication patterns within the family G. Lack of supportive relationship among family members H. Negative attitude/philosophy in life which is not conducive to health maintenance and personal development I. Lack of/inadequate competencies in relating to each other for mutual growth and maturation 5. Failure to utilize community resources for health care due to: A. Lack of/inadequate knowledge of community resources for health care B. Failure to perceive the benefits of health care/services C. Lack of trust/confidence in the agency/personnel D. Previous unpleasant experience with health worker E. Fear of consequences of action, specifically: 1. Physical/psychological consequences 2. Financial consequences 3. Social consequences F. Unavailability of required care/service G. Inaccessibility of required care/service due to: 1. Cost constraints 2. Physical inaccessibility H. Lack of or inadequate family resources, specifically: 1. Manpower resources 2. Financial resources I. Feeling of alienation to/lack of support from the community J. Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care ASSESSMENT 1. Pre-test/Post Test 2. Case Study References: 1. Books Cuevas, F.P. (2007). Public health Nursing in the Philippines (10 th Ed.). National League of Philippine Government Nurses, Incorporated Maglaya, A. S. (2004). Nursing practice in the community (4th ed.). Argonauta Corporation David, E., Rodolfo M.J.L., Serraon-Claudio, V., Jamorabo-Ruiz, A. (2007). Community Health Nursing, An Approach to Families and Population Group. Merriam & Webster Bookstore Inc. Prepared by: NCM 104A Lecturers NCM 104a_rpilloc/vjgasat_Module 3_Family_Nursing_Care