First Level Assessment
The initial step in formulating a family care plan involves a thorough assessment to identify existing and potential health conditions within the family unit. This process categorizes health conditions into distinct areas, starting with wellness conditions.
I. Presence of Wellness Condition
Wellness conditions are identified as “Potential” or “Readiness,” indicating a clinical judgment about a family’s progression from their current state of well-being to a higher level. Wellness potential is assessed based on the family’s current performance, competencies, clinical data, or expressed desire for improvement in health promotion and maintenance. Examples include:
A. Potential for Enhanced Capability for:
- Healthy Lifestyle: Encompassing aspects like nutrition/diet and exercise/activity.
- Health Maintenance/Health Management: Proactive behaviors to sustain health.
- Parenting: Skills and practices that support child development and family well-being.
- Breastfeeding: Optimal infant feeding practices.
- Spiritual Well-being: The family’s journey towards inner harmony and connection to a sacred source.
- Others: (Specify)
B. Readiness for Enhanced Capability for:
- Healthy Lifestyle
- Health Maintenance/Health Management
- Parenting
- Breastfeeding
- Spiritual Well-being
- Others: (Specify)
II. Presence of Health Threats
Health threats are conditions that increase the likelihood of disease or accidents, potentially hindering wellness or optimal health potential. These can include:
A. Presence of Risk Factors for Specific Diseases: Such as lifestyle diseases and metabolic syndrome, or habits like smoking.
B. Threat of Cross-Infection from Communicable Disease Cases: Risk of infection spread within the family.
C. Family Size Exceeding Resource Capacity: When family size strains available resources.
D. Accident Hazards: (Specify)
- Broken Chairs: Furniture in disrepair posing physical risks.
- Pointed/Sharp Objects, Poisons, and Medicines Improperly Kept: Unsafe storage of hazardous items.
- Fire Hazards: Conditions increasing the risk of fire.
- Fall Hazards: Environmental factors that could lead to falls.
- Others: (Specify)
E. Faulty/Unhealthful Nutritional/Eating Habits or Feeding Techniques/Practices: (Specify)
- Inadequate Food Intake: Insufficient quality or quantity of food.
- Excessive Intake of Certain Nutrients: Imbalances in dietary intake.
- Faulty Eating Habits: Poor eating patterns.
- Ineffective Breastfeeding: Challenges in breastfeeding practices.
- Faulty Feeding Techniques: Improper methods of feeding.
F. Stress Provoking Factors: (Specify)
- Strained Marital Relationship: Marital discord causing family stress.
- Strained Parent-Sibling Relationship: Conflict between parents and children or among siblings.
- Interpersonal Conflicts Between Family Members: Disagreements and disputes within the family.
- Care-giving Burden: Stress associated with providing care to a family member.
G. Poor Home/Environmental Condition/Sanitation: (Specify)
- Inadequate Living Space: Overcrowded or insufficient living area.
- Lack of Food Storage Facilities: Absence of proper food storage.
- Polluted Water Supply: Contaminated water sources.
- Presence of Breeding or Resting Sites of Disease Vectors: Conditions attracting disease-carrying organisms.
- Improper Garbage/Refuse Disposal: Inadequate waste management.
- Unsanitary Waste Disposal: Unhygienic disposal of human waste.
- Improper Drainage System: Poor drainage leading to unsanitary conditions.
- Poor Lighting and Ventilation: Inadequate light and air circulation.
- Noise Pollution: Excessive noise levels.
- Air Pollution: Contaminated air quality.
H. Unsanitary Food Handling and Preparation: Unhygienic practices in food preparation.
I. Unhealthy Lifestyle and Personal Habits/Practices: (Specify)
- Alcohol Drinking: Excessive or harmful alcohol consumption.
- Cigarette/Tobacco Smoking: Tobacco use.
- Walking Barefooted or Inadequate Footwear: Lack of foot protection.
- Eating Raw Meat or Fish: Risk of foodborne illness.
- Poor Personal Hygiene: Inadequate hygiene practices.
- Self-Medication/Substance Abuse: Misuse of medications or drugs.
- Sexual Promiscuity: Risky sexual behaviors.
- Engaging in Dangerous Sports: Participation in high-risk activities without proper safety measures.
- Inadequate Rest or Sleep: Insufficient sleep.
- Lack of/Inadequate Exercise/Physical Activity: Sedentary lifestyle.
- Lack of Relaxation Activities: Insufficient stress-reducing activities.
- Non-use of Self-Protection Measures: Failure to use preventative measures like bed nets in malaria-prone areas.
J. Inherent Personal Characteristics: (e.g., poor impulse control).
K. Health History: Past health issues that may contribute to current health deficits.
L. Inappropriate Role Assumption: (e.g., child taking on parental roles).
M. Lack of Immunization/Inadequate Immunization Status, Especially in Children: Incomplete vaccination records.
N. Family Disunity:
- Self-Oriented Behavior of Members: Individualistic actions undermining family cohesion.
- Unresolved Conflicts: Lingering disputes within the family.
- Intolerable Disagreement: Severe and persistent disagreements.
O. Others: (Specify)
III. Presence of Health Deficits
Health deficits represent instances where health maintenance has failed, manifesting as:
A. Illness States: Diagnosed or undiagnosed medical conditions.
B. Failure to Thrive/Develop According to Normal Rate: Developmental delays in children.
C. Disability:
- Congenital or acquired disabilities, whether temporary (e.g., aphasia or temporary paralysis after a CVA) or permanent (e.g., limb amputation, blindness from measles, lameness from polio).
IV. Presence of Stress Points/Foreseeable Crisis Situations
These are anticipated periods that place unusual demands on the family’s adjustment capabilities and resources. Examples include:
A. Marriage: The transition to married life.
B. Pregnancy, Labor, Puerperium: Childbearing and postpartum periods.
C. Parenthood: Adjusting to the responsibilities of raising children.
D. Additional Family Member: Welcoming a newborn or other new member.
E. Abortion: Pregnancy loss.
F. Entrance to School: Starting formal education.
G. Adolescence: Navigating teenage years.
H. Divorce or Separation: Family dissolution.
I. Menopause: Hormonal changes in women.
J. Loss of Job: Unemployment of a family member.
K. Hospitalization of a Family Member: Dealing with a family member’s illness and hospital stay.
L. Death of a Member: Bereavement and loss.
M. Resettlement in a New Community: Relocation and adaptation to a new environment.
N. Illegitimacy: Birth outside of marriage.
O. Others: (Specify)
Typology of Nursing Problems in Family Nursing Practice
Image alt text: Diagram illustrating the typology of nursing problems in family nursing practice, detailing wellness conditions, health threats, health deficits, and stress points as part of a family care plan diagnosis.
Second-Level Assessment
The second level of assessment delves into the nature of nursing problems families face in managing their health tasks related to identified health conditions. This involves understanding the family’s capacity and willingness to act.
I. Inability to Recognize the Presence of the Condition or Problem Due to:
A. Lack of or Inadequate Knowledge: Insufficient understanding of health issues.
B. Denial: Rejecting the existence or severity of a problem due to:
- Social Stigma: Fear of social disapproval.
- Economic/Cost Implications: Concerns about financial burdens.
- Physical Consequences: Apprehension about physical impacts.
- Emotional/Psychological Issues/Concerns: Emotional distress or psychological barriers.
C. Attitude/Philosophy in Life: Beliefs that hinder problem recognition.
D. Others: (Specify)
II. Inability to Make Decisions Regarding Appropriate Health Action Due to:
A. Failure to Comprehend the Nature/Magnitude of the Problem/Condition: Lack of understanding about the scope of the health issue.
B. Low Salience of the Problem/Condition: Perceiving the problem as unimportant.
C. Feelings of Confusion, Helplessness, and/or Resignation: Overwhelmed by the situation’s perceived severity.
D. Lack of/Inadequate Knowledge/Insight into Alternative Actions: Unawareness of available options.
E. Inability to Decide Among Alternatives: Difficulty choosing a course of action.
F. Conflicting Opinions Among Family Members: Disagreements on the best approach.
G. Lack of/Inadequate Knowledge of Community Resources: Unfamiliarity with available support services.
H. Fear of Consequences of Action: Apprehension about potential outcomes, including:
- Social Consequences
- Economic Consequences
- Physical Consequences
- Emotional/Psychological Consequences
I. Negative Attitude Towards the Health Condition: Attitudes hindering rational decision-making.
J. Inaccessibility of Appropriate Resources: Barriers to accessing care, including:
- Physical Inaccessibility: Geographical or logistical barriers.
- Cost Constraints: Financial limitations.
K. Lack of Trust/Confidence in Health Personnel/Agency: Distrust in healthcare providers or institutions.
L. Misconceptions or Erroneous Information: Inaccurate beliefs about treatment or care.
M. Others: (Specify)
III. Inability to Provide Adequate Nursing Care to a Family Member Due to:
A. Lack of/Inadequate Knowledge About the Disease/Health Condition: Insufficient understanding of the illness, its management, and prognosis.
B. Lack of/Inadequate Knowledge About Child Development and Care: Limited understanding of child-rearing practices.
C. Lack of/Inadequate Knowledge of the Nursing Care Needed: Unawareness of the level of care required.
D. Lack of Necessary Facilities, Equipment, and Supplies: Insufficient resources for caregiving.
E. Lack of/Inadequate Skill in Carrying Out Interventions: Inexperience in performing necessary treatments or procedures.
F. Inadequate Family Resources for Care:
- Absence of Responsible Member: Lack of available caregivers.
- Financial Constraints: Limited financial resources for care.
- Limitation of Physical Resources: Lack of physical capacity to provide care.
G. Significant Persons Unexpressed Feelings: Negative emotions (hostility, guilt, fear, anxiety, despair, rejection) impacting caregiving ability.
H. Philosophy in Life Hindering Care: Beliefs that impede caring for vulnerable family members.
I. Member’s Preoccupation with Own Concerns: Self-absorption detracting from caregiving.
J. Prolonged Disease or Disabilities: Long-term conditions exhausting family support.
K. Altered Role Performance: (Specify)
- Role Denials or Ambivalence: Unwillingness or uncertainty in assuming roles.
- Role Strain: Difficulty fulfilling role demands.
- Role Dissatisfaction: Unhappiness with assigned roles.
- Role Conflict: Clashing role expectations.
- Role Confusion: Uncertainty about role responsibilities.
- Role Overload: Excessive role demands.
L. Others: (Specify)
IV. Inability to Provide a Home Environment Conducive to Health Maintenance and Personal Development Due to:
A. Inadequate Family Resources:
- Financial Constraints: Limited funds for home improvements.
- Limited Physical Resources: Lack of space or materials for improvements.
B. Failure to See Benefits of Home Environment Improvement: Lack of awareness of the long-term advantages.
C. Lack of/Inadequate Knowledge of Hygiene and Sanitation: Insufficient understanding of healthy home practices.
D. Lack of/Inadequate Knowledge of Preventive Measures: Unawareness of preventative actions.
E. Lack of Skill in Improving Home Environment: Inability to implement necessary changes.
F. Ineffective Communication Pattern Within the Family: Poor communication hindering home environment improvements.
G. Lack of Supportive Relationships: Absence of mutual support among family members.
H. Negative Attitudes/Philosophy Not Conducive to Health: Beliefs that undermine health and well-being.
I. Lack of Competencies in Relating for Mutual Growth: Reduced capacity to meet each other’s needs due to family problems.
J. Others: (Specify)
V. Failure to Utilize Community Resources for Health Care Due to:
A. Lack of/Inadequate Knowledge of Community Resources: Unawareness of available services.
B. Failure to Perceive Benefits of Health Care/Services: Not recognizing the value of community health services.
C. Lack of Trust/Confidence in Agency/Personnel: Distrust in community health providers.
D. Previous Unpleasant Experience with Health Worker: Negative past interactions.
E. Fear of Consequences of Action: Apprehension about outcomes of seeking help:
- Physical/Psychological Consequences
- Financial Consequences
- Social Consequences
F. Unavailability of Required Care/Services: Lack of necessary services in the community.
G. Inaccessibility of Required Services: Barriers to accessing services:
- Cost Constraints
- Physical Inaccessibility
H. Lack of/Inadequate Family Resources:
- Manpower Resources: Lack of available caregivers to facilitate service use.
- Financial Resources: Insufficient funds for service costs.
I. Feeling of Alienation/Lack of Support from Community: Feeling disconnected from community support systems.
J. Negative Attitude Hindering Resource Utilization: Beliefs discouraging the use of community health resources.
K. Others: (Specify)
