NCM 104 Lecture Family Health Nursing Process PDF

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FAMILY HEALTH NURSING PROCESSReview of the Nursing Process NURSING PROCESS It is a scientific and systematized approach to health to care for individuals, families and communities. It is the means by which nurses address the health needs and problems of their clients and illness prevention It is a s...

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FAMILY HEALTH NURSING PROCESS Review of the Nursing Process NURSING PROCESS It is a scientific and systematized approach to health to care for individuals, families and communities. It is the means by which nurses address the health needs and problems of their clients and illness prevention It is a systematic, client-centered method or structuring the delivery of nursing care Nursing process is a systematic, rational method of planning and providing individualized nursing care. The purpose of nursing process 1. To identify client’s health status, actual or potential healthcare problems or need. 2. To establish plans to meet the identified needs and to deliver specific interventions to meet those needs. 3. It provides a framework in which to practice nursing. Characteristics of a nursing process: 1. Dynamic and cyclic 2. Patient centered 3. Goal directed 4. Open and Flexible 5. Problem Oriented 6. Planned 7. Universally accepted 8. Interpersonal and collaborative 9. Holistic 10. Systematic Benefits of Nursing Process 1. Improves the quality of care that the client receives 2. Ensures a high level of client participation together with continuous evaluation designed to meet the client’s unique needs 3. Enables nurses to use time and resources efficiently to both their own and their client’s benefit The steps of the Nursing Process 1. Assessment 2. Nursing Diagnosis 3. Planning 4. Implementation 5. Evaluation Nursing Assessment The process of collecting, validating and recording data about a client’s health status. It identifies patient’s strengths and limitations and is done continuously throughout the nursing process. Nursing Diagnosis In this phase the nurse sort, clusters and analyzes data. These questions could serve as guidelines: What are the actual and potential health problems for which the client needs nursing assistance? What factors contributed to this problem? Nursing diagnoses are identified through actual and potential health problems or responses to life processes. Types of nursing diagnosis: It can be ACTUAL, POTENTIAL or WELLNESS DIAGNOSIS : ACTUAL – identifies an occurring health problem POTENTIAL – identifies a high risk health problem WELLNESS‐ focused on promoting or enhancing a patient’s level of wellness. Planning Planning expected outcomes to resolve or minimize the identified problems of the client. In collaboration with the client, the nurse develops specific nursing intervention for each nursing diagnosis. Its components are the following: 1. formulation of objectives 2. Setting Priorities 3. Formulating nursing care pianWriting nursing order Implementation These are actions taken to improve or help a situation”. It is considered a strategy or planned action to accomplish the desired outcome or goal of a specific situation. Intervention s “any treatment based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes” (Moorhead, Johnson, Maas, & Swanson, 2018). In the nursing profession, the word intervention refers to planned activities carried out by a nurse to ensure that a patient complains is addressed and are in place in order to manage the care of the patient. Also called intervention; putting the nursing care plan into action to achieve goals and outcomes As you implement your plan, you continue to assess your patient’s responses and modify plan as needed. The doing phase of the nursing process. Care done should always be documented. There are 3 identified nursing functions 1.Independent nursing function- based on the sound judgement of the nurse 2.Dependent nursing function- doctor’s orders are followed 3.Collaborative or interdependent nursing function- coordination with other members of the health care team Evaluation

Assessing the client s response to nursing interventions and then comparing the response to the goals or outcome criteria written in the planning phase FAMILY HEALTH The continuing ability to meet defined functions in interaction with other social, political, economic and health system. Possessing the abilities and resources to accomplish family developmental tasks.

FAMILY HEALTH NURSING PROCESS Family nursing process is the same, whether the focus is the famiily as patient or as environment. The goal is to help the family reach and maintain its maximum health in a given situation. PRINCIPLES OF FAMILY HEALTH CARE 1. Establishing good professional relationship with the family 2. Proper education and guidance should be provided 3. Gather all relevant information about family to identify problem and set priorities 4. Provide need-based support and services to the family to improve their health status 5. Health care services should be provided to the family irrespective of their age, sex, income, religion, etc. 6. Duplication of health services should be avoided 7. Proper health message to be communicated to family in every contact STEPS OF FAMILY HEALTH NURSING PROCES 1. ASSESSMENT 2. FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS 3. PLANNING 4. IMPLEMENTATION 5. EVALUATION PHASE I. ASSESSMENT Family Health Nursing Assessment This involves 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 and resolve problems in order to achieve health and well-being among its members. Data Collection Data Analysis Diagnosis DATA COLLECTION Two important things to ensure Effective and Efficient Data Collection in Family Nursing Practice: Identify the types of kinds of data needed Specify the methods of data gathering and necessary tools for gathering data DATA ANALYSIS - sorting out and classifying or grouping data by type of nature. ANALYZE DATA TO IDENTIFY NEEDS AND PROBLEMS 1. Criteria for analysis 2. Process for analysis sorting of data clustering of related cues distinguishing relevant from irrelevant cues identifying patterns comparing patterns interpreting results of comparison making inferences and drawing conclusions NURSING DIAGNOSIS The end result of the secondary level assessment and a set of family nursing problems for each health condition or problem First major phase of nursing process in family health nursing It Involves a set of action by which the nurse measures the status of the family as a client. Its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and wellness among its members Data about present condition or status of the family are compared against the norms and standards of personal, social, and environmental health, system integrity and ability to resolve social problems. The norms and standards are derived from values, beliefs, principles, rules or expectation. TWO MAJOR TYPES 1. FIRST LEVEL ASSESSMENT- a process whereby existing and potential health conditions or problems of the family are determined (WS, HT, HD, SP or FC) 2. SECOND LEVEL ASSESSMENT- defines the nature or type of nursing problem that family encounters in performing health task with respect to given health condition or problem and etiology or barriers to the family’s assumption of the task DATA COLLECTION METHODS: SELECT APPROPRIATE METHOD 1. OBSERVATION It is done through use of sensory capacities The nurse gathers information about the family’s state of being and behavioral responses. The family’s health status can be inferred from the signs /symptoms of problem areas within the following areas: a. communication and interaction patterns expected, used, and tolerated by family members b. role perception / task assumption by each member including decision making patterns c. conditions in the home and environment Data gathered though this method have the advantage of being subjected to validation and reliability testing by other observers. 2. PHYSICAL EXAMINATION Health assessment of every member of the family, significant data about the health status of individual members can be obtained through direct examination through IPPA, measurement of specific body parts and reviewing the body systems. Data gathered form substantive part of first level assessment which may indicate presence of health deficits (illness state) 3. INTERVIEW Productivity of interview process depends upon the use effective communication techniques to elicit needed response. Problems encountered during interview: a. How to ascertain where the client is in terms of perception of health condition or problems and the patterns of coping utilized to resolve them b. Tendency of community health worker to readily give out advice, health teachings or solutions once they have identified the health condition or problems. c. Provisions of models for phrasing interview questions utilization of deliberately chosen communication techniques for an adequate nursing assessment.

d. Confidence in the use of communication skills e. Being familiar with and being competent in the use of type of question that aim to explore, validate, clarify, offer feedback, encourage verbalization of thought and feelings.

What to collect during interview? 1. completing health history of each family member Health history determines current health status based on significant: a. PAST HEALTH HISTOI\RY e.g. developmental accomplishment, known illnesses, allergies, restorative treatment, residence in endemic areas for certain diseases or sources of communicable diseases. b. FAMILY HISTORY e.g. genetic history in relation to health and illness. c. SOCIAL HISTORY e.g. intra-personal and inter-personal factors affecting the family member social adjustment or vulnerability to stress and crisis 2. 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 problem exist in the family (first level assessment) and the corresponding nursing problems for each health condition or problem (2nd level assessment) 4. RECORDS REVIEW Gather information through reviewing existing records and reports pertinent to the client Individual clinical records of the family members, laboratory and diagnostic reports, immunization records reports about home and environmental conditions 5. LABORATORY/ DIAGNOSTIC TEST Tools Used in Family Assessment Genogram Ecomap Initial Data Base Family Assessment Guide Genogram Graphic representation of a family tree that displays detailed data on relationships among individuals Goes beyond a traditional family tree by allowing the user to analyze hereditary patterns and psychological factors that punctuate relationships Information on disorders running in the family such as alcoholism, depression, diseases, alliances, and living situations Four Rules to build a Genogram: 1. The male parent is always at the left of the family and the female parent is always at the right of the family. 2. In the case of ambiguity, assume a male-female or female-female relationship. 3. Spouse must always be closer to his/her first partner, then the second partner (if any), third partner, and so on . . . 4. The oldest child is always at the left his family, the youngest child is always at the right his family FAMILY ASSESSMENT INITIAL DATA BASE FOR FAMILY NURSING PRACTICE I. Family Structure, characteristics and dynamics II. Socio-economic and cultural characteristics III. Home and environment IV. Health status of each member V. Values and practices on health promotion/maintenance and disease prevention» FAMILY STRUCTURE CHARACTERISTICS AND DYNAMIC This includes the following: a. composition and demographic data of the members of the family/household b. their relationship to the head and place of residence c. the type of family d. family interaction/communication e. Decision making patterns and dynamics SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS This includes the following: a. Income and Expenses b. Occupation, place of work, and income of each working member c. Adequacy to meet basic necessities d. Who makes decisions about money and how it is spent e. Educational attainment of each family member f. Ethnic background and religious affiliations g. Significant others-roles they play in the family’s life h. Relationship of the family to the larger community (membership in organizations) HOME AND ENVIRONMENT a. Housing: Adequacy of living space Sleeping arrangement Food storage and cooking facilities Water supply, toilet facilities Presence of accident hazards Garbage disposal b. Kind of neighborhood c. Social and Health Facilities d. Communication and transportation facilities available HEALTH STATUS OF EACH MEMBER a. Medical and nursing history indicating current and past significant illness or beliefs and practices conductive to health and illness b. Nutritional and developmental status c. Developmental assessment of infants, toddlers and preschoolers d. Risk factor assessment e. Physical assessment findings f. Significant results of laboratory/diagnostic tests/screening procedures

g. Decision making on which or whom to seek advice regarding health VALUES AND PRACTICE ON HEALTH PROMOTION/MAINTENANCE AND DISEASE PREVENTION a. Immunization status of the family members b. Healthy lifestyle practices

c. Adequate of: rest/sleep, exercise/activities, use of protective measures, relaxation and stress management d. Utilization of health care facilities FORMULATION OF FAMILY NURSING PROBLEM/DIAGNOSIS Family profile and diagnosis Family profile implies brief description of family structure and characteristics, family life cycle and culture, socio economic conditions environmental factors health and medical history etc. Family health diagnosis is the written statement of family health problems which are assessed from analysis of data collected. FIRST LEVEL ASSESSMENT Name or Categories of Health Problems 1. Presence of Wellness Condition Stated as Potential or Readiness A clinical or nursing judgment about a client transition form a specific level of wellness or capability to a higher level (NANDA, 2001) Wellness Potential It is a nursing judgement on wellness state or performance current competencies expression of client’s desire E.g. Potential for Enhanced Capability for parenting 2. Presence of Health Threats Readiness for Enhanced Wellness State It is a nursing judgement on wellness state or condition based on client’s current competencies or performance, clinical data and explicit expression of desire to achieve higher level or function in a specific area on health promotion and maintenance. e.g Readiness for Enhanced Capability for Healthy Lifestyle 2. Presence of Health Threats These are conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. E.g. Presence of Risk Factors of specific disease, accident hazards, poor home/ environmental conditions, family history of hereditary disease, threat of cross infection, faulty eating habits, poor environmental sanitation, unhealthy lifestyle/personal habits 3. Presence of Health Deficits These are instances of failure in health maintenance e.g. Illness states, diagnosed or undiagnosed by medical practitioner, disability, transient (aphasia or temporary paralysis after a CVA), permanent (leg amputation secondary to diabetes, lameness from polio) 4. Presence of Stress Points/Foreseeable Crisis Anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources. e.g. marriage, pregnancy, parenthood, divorce, separation, loss of job, menopause death SECOND LEVEL ASSESSMENT Determining family’s ability to perform the Family Health Tasks on each health threat, health deficit, foreseeable crisis on wellness potential. Family Health Condition - a statement of family’s capabilities to maintain health and prevent illness Ability to recognize signs of health and development Ability to manage health and non-health crisis Ability to provide health care to its members Ability to provide home environment conducive to good health and personal development Ability to utilize community resources for health care FAMILY NURSING PROBLEM Five Main Types: Inability to recognize the presence on the condition/problem due to… Inability to make decisions with respect to taking appropriate health action due to… Inability to provide nursing care to the sick, disabled, or dependent member of the family due to… Inability to provides a home environment which is conducive to health maintenance and personal development due to… Failure to utilize community resources for health due to… TYPOLOGY OF PROBLEMS IN FAMILY HEALTH (SECOND LEVEL) 1. Inability to recognize the presence on the condition/problem due to: 1. Lack of inadequate knowledge 2. Denial about its existence or severity as result of fear of consequences of diagnosis of problem 3. 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: 1. Failure to comprehend the nature/magnitude of the problem/condition 2. Low salience of the problem 3. Feeling of confusion, helpnesness, and/or resignation brought about by perceived magnitude/severity of the situation or problem 4. Lack of knowledge as the alternative courses of action open to them 5. Inability to decide which action to take from among a list of altenatives 6. Conflicting opinions among family members 7. Lack of knowledge of community resources for care. 8. Fear of consequences action 9. Negative attitude towards the health condition or problems 10. Inaccessibility of appropriate resources of care 11. Lack of trust /confidence in the health personnel/agency 12. Misconceptions or erroneousinformation about proposed course of action 3. Inability to provide adequate care to the sick,disabled,dependentor vulnerable/at riskmember of the family due to: 1. Lack of knowledge about the disease/health condition 2. Lack of knowledge about child development and care

3. Lack of knowledge of the nature and extent of care needed 4. Lack of the necessary facilities, equipments and supplies of care 5. Lack of inadequate knowledge and skillin carrying out the necessary interventions 6. Inadequate family resources for care

7. Significant person’s unexpressed feelings 8. Philosophy in life which negates or hinders caring for the sick, disabled, dependent and at risk member 9. Member’s pr eoccupation with own concerns or interests 10. Prolonged disease or disability progression which exhaust supportive capacity of family members 11. Altered role performance 4. Inability to provides a home environment which is conducive to health maintenance and personal development due to: 1. Inadequate family resources 2. Failure to see benefits of investment in home and environment improvement 3. Lack of knowledge of preventive measures 4. Lack of skill in carrying out measures to improve home environment 5. Ineffective communication patterns with the family 6. Lack of supportive relationship among family members 7. Negative attitude in life which is not conducive to health maintenance and personal development 8. Lack of competencies in relating to each other for mutual growth and maturation 5. Failure to utilize community resources for health due to: 1. Lack of knowledge of community resources for health 2. Failure to perceive the benefits health services 3. Lack of trust or confidence in the agency personnel 4. Previous unpleasant experience with health worker 5. Fear of consequences in action 6. Unavailability of required care 7. Inaccessibility of required care 8. Inadequate family resources 9. Feeling of alienation to the community. 10. Negative attitude in life which hinders effective utilization of community resources for health care. III. PLANNING PHASE (FAMILY HEALTH AND NURSING CARE PLAN FORMULATION) It is based on the analysis of diagnosed health problems and assessment of family’s ability to resolve problems, establish priorities, setting goals and objectives, formulating family health nursing care plan. 1. Analysis of diagnosed health problems and assessment of family’s ability to resolve problems Family’s ability to resolve health problems can be assessed on the basis of: a. ability to recognize the presence of health problems b. ability to make decisions f...