FAMILY HEALTH CARE NURSING : CHAPTER 2: ASSESSMENT IN FAMILY HEALTH NURSING PRACTICE
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Course
FAMILY HEALTH CARE PRACTICE
Institution
FAMILY HEALTH CARE PRACTICE
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 needs or problems and enhance functioning for growth and development, coping with illness or loss, mobilizing resources and...
CHAPTER 2: ASSESSMENT IN FAMILY HEALTH NURSING PRACTICE
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 needs or problems and enhance functioning for growth and development, coping with illness or loss,
mobilizing resources and maintaining an environment that support wellness and health.
Family Health 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 nurse in
enhancing wellness or addressing problems on health and illness.
The family systems theory views the family as a living social system within a context in which multiple environmental
actions or factors occur over the life course.
- the behaviors of different members are complementary or reciprocal, involving give and take, action or reaction.
- the family as a system has boundaries of filtering mechanisms i.e., norms, values attitudes and rules. Which
regulates the amount of flow of energy, information, resources and stimuli to and from the external environment,
or between the family members as subsystems with separate boundaries affecting each other and the family
system and the system as whole.
The interactional approach or symbolic interactional framework
– this views the family as a unity of interacting personalities whose actions are based on meanings they derive
from interactions and taken in an ever-changing process of interactions, new interpretations, and new meanings.
Symbolic communication evolving from the self and the environment helps individuals interpret and select the
environment to which they respond. This framework identifies how relationships with others affect an individual’s
functioning.
- emphasizes the antecedents and consequences of such processes as communication, decision-making and
problem solving; conflict management / resolution; reactions to stress and other family situation influenced by
family interactions and interactive processes.
The developmental approach
- views family development throughout its generational life cycle, highlighting critical periods of family growth
and development across the life. To illustrate, in the life cycle stage of families with young children, the key
principle of emotional process of transition is accepting new members into the family system as the couple adjust
to make space for children joining them and joining childbearing, financial and household task.
Structural – Functional perspective
– specifies family characteristics such as a member role, family forms (nuclear, single, single – parent, blended,
extended) Power structures (matriarchal, patriarchal).
According to Denham these processes are
1. Caregiving
2. Cathexis (emotional bond 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)
, 5. Communication
6. Connectedness
7. Coordination
Denham’s family routines
1. Self – care routines – patterned behavior related to usual activities of daily living experienced across life course,
dietary, hygiene, sleep-rest, physical activity and exercise gender and sexuality.
2. Safety and prevention – health protection, disease prevention.
3. Mental Health Behaviors - self-esteem, personal integrity.
4. family care – daily activities, traditional behaviors and special celebrations
5. illness care – ways by which members make decisions related to health care needs; choose when, where and
how to seek supportive health supportive health services.
6. Member Care Giving – provision of care during illness, supportive member actions and member roles and
responsibilities.
Nursing Assessment: Operational Framework
- is the first major phase of the nursing process.
- includes data collection, data analysis or interpretation and problem definition or nursing diagnosis.
First – level assessment: is a process whereby a data about the current health status of individual members, the
family as s system and its environment are compared against norms or standards of personal, social and
environmental and interactions, interpersonal relationships within the family system.
As end result of data analysis during the first level – assessment, specific health conditions or problems are
identified and categorized as
a. Wellness state
b. Health threats
c. Health deficits
d Stress points or foreseeable crisis situations
Second-level assessments – specifically, the nursing problems that the family encounters in performing the health
task with respect to a given health condition or problem, the causes, barriers or etiology of the family’s inability
to perform the task.
See Pages 56: Nursing Practice in the Community
DATA COLLECTION
Firstly, she has to identify the types or kinds of data needed.
Secondly, she needs to specify the methods of data-gathering and the necessary tools to collect such data.
Types of Data in Family Nursing Assessment
, What data are needed to arrive at a measure of the family's ability to achieve health and well-being among its
members, while it maintains itself as a system and as a functioning unit? Based on theoretical frameworks which
describe family characteristics, explain and predict family behavior, two types of data are needed at two levels of
assessment in
family nursing practice.
As shown on Table 2.1 (Assessment Data Base) the following constitute the first type of data taken during the
first-level assessment:
1. Family structure, characteristics and dynamics- include family composition and demographic data, type of family form
and structure, decision-making patterns, interpersonal relationships, interactional patterns/interpersonal relationships
(such as presence of dyadic and triadic boundaries which have the potential to alter members' diverging health beliefs,
knowledge and behavior) and communication patterns or processes affecting family relatedness (e.g., expression of
feelings or emotions particularly related with addressing converging and diverging motivations or perceptions, such as
during conflict) consistency and congruence between intended and received messages; and, explicitness of message for
appropriateness, effectivity and efficiency of the communication process related with role performance, individual
members' health and family system integrity.
2. Socio-economic and cultural characteristics-include occupation, place of work, and income of each working member;
educational attainment of each family member; ethnic background and religious affiliation; family traditions, events or
practices affecting members' health or family functioning; significant others and the role(s) they play in the family's life;
and the relationship of the family to the larger community.
3. Home and environment-include information on housing and sanitation facilities; kind of neighborhood and availability
of social, health, communication and transportation facilities in the community.
4. Health status of each member-includes current and past significant health condition/s or illness/es; beliefs and
practices conducive to health and illness; nutritional and developmental status; physical assessment findings and
significant results of laboratory/diagnostic tests/screening procedures.
5. Values and practices on health promotion/maintenance and disease prevention-include use of promotive preventive
services as evidenced by immunization status of at-risk members and use of another healthy lifestyle related services;
adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle practices;
opportunities which enhance feelings of self-worth, self-efficacy and connectedness to self, others and a higher power;
essence of meaningfulness.
DATA GATHERING METHODS AND TOOLS
1. Observation
2. Physical Examination
3. Interview
4. Record Review
5. Laboratory / Diagnostic test
Assessment Data Base - is supported and complemented by other family assessment tools to elicit generational
information about the family structure and processes.
Genogram - graphically displays information about family members and their relationships over atleast three
generations.
, DATA ANALYSIS
1. Sorting Data for broad categories such as related with the health status or practices of 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.
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 standard of
health.
6. Interpreting results based on how family characteristics, values, attitudes, perceptions, lifestyles,
communication etc.
7. Making inferences or drawing conclusions about the reasons for the existence of the health or condition or
problem and risk factor related to non-maintenance of wellness state which can be attributed to non-
performance of family health tasks.
MAKING A DIAGNOSIS
1. Definition of wellness state/ potential or health condition or problems such as an end product of first level
assessment.
2. Definition of family nursing problems as an end result of send level assessment.
Family Nursing Problem is stated as an inability to perform a specific health task and the reasons (Etiology) why the
family cannot perform a certain task.
A tool for gathering this assessment data base (ADB)is Presented in Table 2. Through this ADB, the nurse identifies
existing and potential wellness state/s, health threats, health deficits and stress points/foreseeable crises in a given
family.
Each family has its own way of behaving towards or responding to situations in the face of these problems. The other
type of data taken during the 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 condition or problem;
2. Decisions made and appropriateness; if none, reasons, and
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