FAMILY DATA ANALYSIS AND FAMILY NURSING DIAGNOSIS - After collecting data, these are analyzed, sorted out and grouped. The synthesized information will be compared to the norm to determine the nature and sources of the data gathered. - From the inference made conclusion are formed. Hence, diagnoses are formulated and priorities set for planning and implementation. - Health problems are categorized according to factors affecting priority status. NATURE : 1. Health Threat – condition 2. Health Deficit – may lead to illness. 3. Foreseeable crisis Health deficits receive more attention than health threats due to immediate intervention, while foreseeable crises are less influenced by culture. Modifiability The community health manager must consider some important factors in defining modifiability of the health problems- or probability of success in minimizing, alleviating or totally eradicating the problem through health intervention. 1. Current knowledge, technology and intervention to manage the problem 2. Resources of the family (Physical, financial, manpower) 3. Resources of the community (facilities and community organizations) 4. Resources of the community health manager knowledge skill and time) Preventive Potentials To decide on the appropriate score for the preventive potential of the health problem- or the nature and magnitude of future problems that can be minimized or preventive if intervention is done, the following factors are considered: 1. Severity of the problem - the more severe or advanced the problem, the lower the preventive potential 2. Duration of the problem - the longer the problem has existed, the lower the preventive potential. 3. Current management - application of appropriate intervention increases the problem’s preventive potentials Salience - To determine the salience score, evaluate the family’s perception ad evaluation of the problem in terms of seriousness and urgency of attention needed. The family’s concern and felt needs require priority attention. Listing and Categorizing Health Problems Example: Family No. 1 Name of Family head: Address: 24 Catmon St. Brgy Uno, Sitio Dos List of Health Problem Nature of Problems Cough and Cold of Jose, Jr. Health deficit Scabies of Jeena Health deficit Malnutrition of Jana Health deficit Computing and Justifying Scores of Health Problems EXAMPLE: Family No. 1 Problem: Cough and Fever Criteria 1. Nature of the problem 2. Modifiability 3. Preventive Potentials 4. Salience of the problem Standards Score Health deficit 3 Health threat 2 Foreseeable crisis Weight Computation Actual Score 3/3 1 × 2/3(0.66) 1 1 1/3(0.33) Removable 2 2/2 2 Partially modifiable 1 × 1 Not modifiable 0 2 0 High 3 2/3 1 Moderate 2 × 2/3(0.66) Low 1 1 1/3(0.50) Needs immediate attention 2 2/2 1 Does not need immediate attention 1 Not a problem 0 1 2 1 1 1 2 (0.50) × 1 0 Justification Health Deficit The family and the community have the necessary resources to treat cough and cold Possibility of transferring infection to the other members of the family is high and should, therefore be given immediate attention Mother knows ways of treating coughs and colds and has used herbal medicines Although there is a possibility of transferring infection to the other member, the infection is non-life threatening The highest score is 5 equivalents to the total weight. The nurse considers as priority those conditions and problems with total scores nearer five (5), Thus the higher score of the given problem the more likely it is taken as a priority. With this score, the nurse then ranks health conditions and problems accordingly. The Prioritized Health Problems The list of health condition or problems ranked according to priorities is presented 1. Cough and fever 4.66 2. Scabies 4.5 3. Malnutrition 4.0 The second-level assessment results in family nursing problems for each health condition, focusing on wellness and health issues. Nursing dysfunction occurs when a family fails to perform specific health tasks to improve or manage the health problem. One of the major barriers to the effective operationalization and application of the nursing process in the family health care is the absence of the classification system for nursing problems that reflect the family status and capabilities as a functioning unit. To facilitate the process of defining family nursing problems, a classification system of family nursing problems was developed and filed-tested in 1978. The Typology of Nursing Problems in Family Health Care Freeman's Family Health Tasks serve as the organizing principle for community health nursing practice, focusing on human behavior and response to health and illness. First-level assessment results indicate health conditions, threats, deficits, and stress points, while second-level assessment reveals family nursing problems. Health Problems A. Potential for enhanced capability: • Healthy lifestyle • Healthy maintenance /health management • Parenting • Breastfeeding • Spiritual well-being B. Readiness for enhanced capability for: • Healthy lifestyle • Healthy maintenance /health management • Parenting • Breastfeeding • Spiritual well-being Family Nursing Problems First Level Assessment Second Level Assessment 1. Presence of wellness Condition- stated as potential or readiness- a clinical or nursing judgement about the client in transition from specific level of wellness or capability to a higher level. 1. a. b. Inability to recognize the presence of condition or problem due to: Lack of/inadequate knowledge Denial about its existence or severity as a result of fear of consequences of diagnosis of problems specially: 1. Social stigma, loss of respect of peers/significant others 2. Economic/cost implication 3. Physical consequences 4. Emotional/psychological issues/concerns 5. Attitude/philosophy in life 2. Inability to make decisions with respect to taking appropriate health actions due to: a. Failure to comprehend the nature/magnitude of the problem b. Low salience of the problem c. Feeling of confusion, helplessness/or resignation brought about perceived magnitude, severity of the problem Health Problems A. Presence of risk factors of specific diseases (lifestyle diseases, metabolic syndrome) B. Threats of cross infection from communicable diseases C. Family size beyond what family resources can adequately provide D. Accident hazard • Broken chair • Pointed sharps objects, poisons and medicines improperly kept • Fire hazards • Fall hazards E. Faulty /unhealthy nutrition/eating habit or feeding • Inadequate food intake both quality and quantity • Excessive intake of certain nutrients • Faulty eating habits • Ineffective breast feeding • Faulty feeding techniques F. Stress-provoking factors • Strained marital relationship • Strained parent-sibling relationship • Interpersonal conflicts between family members • Caregiving burden Family Nursing Problems First Level Assessment Second Level Assessment 2. Presence of health deficits- instances of failure in health maintenance d. Lack/inadequate knowledge/insight as to alternative courses of action open to them e. Inability to decide which actions to take from among a list of alternatives f. Lack /inadequate knowledge of community health resources for care g. Fear of consequences of actions: 1. Social consequences 2. Economic consequences 3. Physical consequences 4. Emotional /psychological consequences h. Negative attitude towards health condition i. Inaccessibility of appropriate resources of care 1. Physical accessibility 2. Cost constraints or economic/financial agency j. Lack of confidence /trust in the health personnel/agency k. Misconception or erroneous information about proposed course of action Health Problems Family Nursing Problems First Level Assessment G. Poor home/ environmental condition/sanitation, • Inadequate living space • Lack of food storage facilities • Polluted water supply • Presence of breeding or resting sights of vectors of diseases • Improper garbage /refuse disposal • Insanitary waste disposal • Improper drainage system • Poor lighting and ventilation • Noise pollution • Air pollution H. Unsanitary food handling and preparation 1. Unhealthy lifestyle and personal habits/practices • Alcohol drinking • Cigarette/tobacco smoking • Walking barefoot or inadequate footwear • Eating raw meat or fish • Poor personal hygiene • Self-medication/substance abuse Second Level Assessment 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 disease/health conditions b. Lack of /inadequate knowledge about child development and care c. Lack of /inadequate knowledge of the nature or extent of nursing care needed. d. Lack of necessary care facilities, equipment and supplies e. Lack of/inadequate knowledge or skills in carryout the necessary intervention or treatment or procedures f. Inadequate family resources of care specifically 1. Absence of responsible member 2. 2. Financial constraint 3. 3. Limitation of luck/lack of physical resources g. Significant person’s unexpressed feelings h. Philosophy in life that negates /hinders caring for the sick, disabled, dependent, vulnerable i. Members preoccupation with concerns /interest Health Problems Family Nursing Problems First Level Assessment Sexual promiscuity Engaging in dangerous sports Inadequate rest /sleep Lack of/ inadequate exercise/physical activity • Lack of relaxation activities • Non-use of self-protection measures J. Inherent personal characteristic (poor impulse control) K. Health history, which may induce the occurrence of health deficit L. Inappropriate role assumption (child assuming mother’s role, father not assuming his role M. Lack of immunization/inadequate immunization status N. Family disunity • • • • Second Level Assessment j. Prolonged disease or disabilities, which exhaust supportive capacity of family members k. Altered role performance: 1. Role denial 2. Role strain 3. Role dissatisfaction 4. Role conflict 5. Role confusion 6. Role overload 4. Inability to provide home a home environment conducive to health maintenance and personal development due to: a. Inadequate family resources 1. Financial constraint/limited resources 2. Limited physical resources b. Failure to see benefits of investment in home environment improvement c. Lack/inadequate knowledge of the importance of hygiene and sanitation d. Lack of/ inadequate knowledge on preventive measures e. Lack of skills in carryout measures to improve home environment f. Ineffective communication pattern within the family g. Lack of supportive relationships among family members h. Negative attitudes/philosophy in life i. Lack of/ inadequate competences in relating to each other for mutual growth and maturation Health Problems Family Nursing Problems First Level Assessment Second Level Assessment Illness state, regardless whether it is diagnosed or undiagnosed by medical practitioner B. Failure to thrive/develop according to normal rate C. Disability-whether congenital or arising from illness 3. Presence of Health Threatscondition that are conducive to diseases and accident, or may result to failure to maintain wellness or realize health potentials A. B. C. D. E. F. G. H. I. J. K. L. M. 4. Presence of stress points/ foreseeable crisis situationsanticipated periods of unusual demand on the individual or family in terms of adjustment/family resources 5. Failure to utilize community resources for health care due to: a. Lack/inadequate knowledge of community resources for health b. Failure to perceive the benefits for health care services c. Lack of trust/confidence in the agency /personnel d. Previous unpleasant experience with health worker e. Fear of consequences of actions f. Unavailability of required services due to cost restraints or physical inaccessibility g. Lack of or inadequate family resources h. Feeling of alienation to /lack of support from the community i. Negative attitudes/philosophy in life A. A. Marriage B. Pregnancy, labor, puerperium Parenthood Additional member Abortion Entrance at school Adolescence Divorce or separation Menopause Loss of job Hospitalization of a family member Resettlement in a new community Illegitimacy Nursing assessment is a systematic process for identifying and validating health and nursing problems, ensuring effective client care.
