INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

Family structure, Characteristics, and Dynamicso Members of the household and relationship to the head of the familyo Demographic data – age, sex, civil status, position in the familyo Place of residence of each member – whether living with the family or elsewhereo Type of family structure – e.g. matriarchal or patriarchal, nuclear or extendedo Dominant family members in terms of decision-making, especially in matters of health

careo General family relationship/dynamics – presence of any readily observable conflict

between members; characteristics communication patterns among members Socio-economic and Cultural Characteristics

o Income and Expenses Occupation, place of work and income of each working members Adequacy to meet basic necessities Who makes decisions about money and how it is spent

o Educational attainment of each othero Ethnic background and religious affiliationo Significant Others – role(s) they play in family’s lifeo Relationship of the family to larger community – Nature and extent of participation of

the family in community activities Home and Environment

o Housing Adequacy of living peace Sleeping arrangement Presence of breeding or resting sites of vectors of diseases Presence of accidents hazards Food storage and cooking facilities Water supply – source, ownership, portability Toilet facility – type, ownership, sanitary condition Drainage system – type, sanitary condition

o Kind of neighborhood, e.g. congested, slum, etc.o Social and health facilities availableo Communication and transportation facilities available

Health Status of each Family MemberMedical and nursing history indicatingo current or past significant illnesses or beliefs and practices conducive to health illnesso Nutritional assessment

Anthropometric data: Measures of nutritional status of children, weight, height, mid-upper arm circumference: Risk assessment measures of obesity: body mass index, waist circumference, waist hip ratio

Dietary history specifying quality and quantity of food/nutrient intake per day

Eating/ feeding habits/ practiceso Developmental assessments of infants, toddlers, and preschoolers – e.g., Metro Manilao Risk factor assessment indicating presence of major and contributing modifiable risk

factors for specific lifestyles, cigarette smoking, elevated blood lipids, obesity, diabetes mellitus, inadequate fiber intake, stress, alcohol drinking and other substance abuse

o Physical assessment indicating presence of illness state/so Results of laboratory/diagnostic and other screening procedures supportive of

assessment findings Values, Habits, Practices on Health Promotion, Maintenance and Disease Prevention

o Immunization status of family memberso Healthy lifestyle practices. Specifyo Adequacy of:

rest and sleep exercise use of protective measures- e.g. adequate footwear in parasite-infested areas; relaxation and other stress management activities

o Use of Promotive-preventive health services

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING PRACTICE FIRST-LEVEL ASSESSMENT

o Presence of Wellness Condition – stated as Potential or Readiness- a clinical or nursing judgment about a client in transition from a specific level of wellness or capability to a higher level. Wellness potential is a nursing judgment on wellness state or condition based on client’s performance, current competencies or clinical data but no explicit expression of client desire. Readiness for enhanced wellness state is a nursing judgment on wellness state or condition based on client’s current competencies or performance, clinical data explicit expression of desire to achieve a higher level of state or function in specific area on health promotion and maintenance.

Potential for Enhanced Capability for: Healthy lifestyle – e.g. nutrition/diet, exercise/ activity Health Maintenance Parenting Breastfeeding Spiritual Well-being – process of a client’s unfolding of mystery through

harmonious interconnectedness that comes from inner strength/sacred source/GOD (NANDA 2001)

Others, Readiness for Enhanced Capability for:

Healthy Lifestyle Health Maintenance Parenting

Breastfeeding Spiritual Well-being Others,

o Presence of Health Threats – conditions that are conducive to disease, accident or failure to realize one’s health potential.

Family history of hereditary condition, e.g. diabetes Threat of cross infection from a communicable disease case Family size beyond what family resources can adequately provide Accidental hazards

Broken stairs Sharp objects, poison, and medicines improperly kept Fire hazards

Faulty nutritional habits or feeding practices. Inadequate food intake both in quality & quantity Excessive intake of certain nutrients Faulty eating habits Ineffective breastfeeding Faulty feeding practices

Stress-provoking factors – Strained marital relationship Strained parent-sibling relationship Interpersonal conflicts between family members Care-giving burden

Poor home condition Inadequate living space Lack of food storage facilities Polluted water supply Presence of breeding sites of vectors of disease Improper garbage Unsanitary waste disposal Improper drainage system Poor ventilation Noise pollution Air pollution

Unsanitary food handling and preparation Unhealthful lifestyles and personal habits-

Alcohol drinking Cigarette smoking Inadequate footwear Eating raw meat Poor personal hygiene Self-medication

Sexual promiscuity Engaging in dangerous sports Inadequate rest Lack of inadequate exercise Lack of relaxation activities Non-use of self protection measures

Inherent personal characteristics – e.g. poor impulse control Health history which induce the occurrence of a health deficit, e.g. previous

history of difficult labor Inappropriate role assumption – e.g. child assuming mother's role, father not

assuming his role Lack of immunization/ inadequate immunization status specially of children Family disunity

Self-oriented behavior of member(s) Unresolved conflicts of member(s) Intolerable disagreement Other

Othero Presence of Health Deficits – instances of failure in health maintenance.

Illness states, regardless of whether it is diagnosed or by medical practitioner Failure to thrive/ develop according to normal rate Disability – whether congenital or arising from illness; temporary

o Presence of stress Points/ Foreseeable Crisis Situations – anticipated periods of unusual demand of the individual or family in terms of family resources.

Marriage Menopause Pregnancy Loss of job Parenthood Hospitalization of a family member Additional member Abortion Death of a manner Entrance at school in a new community Resettlement Adolescence Divorce Illegitimacy

Second Level Assessmento Inability to recognize the presence of the condition or problem due to:

Lack of or inadequate knowledge

Denial about its existence or severity as a result of fear of consequences of diagnosis of problem, specifically:

Social-stigma, loss of respect of peer/significant others Economic/cost implications Physical consequences Emotional/psychological issues/concerns

Attitude/philosophy in life which hinders recognition/acceptance of a problem Others, specify: _______________________

o Inability to make decisions with respect to taking appropriate health action due to: Failure to comprehend the nature/magnitude of the problem/condition Low salience of the problem/condition Feeling of confusion, helplessness and/or resignation brought about by

perceived magnitude/severity of the situation or problem, i.e., failure to break down problems into manageable units of attack

Lack of/inadequate knowledge/insight as to alternative courses of action open to them

Inability to decide which action to take from among a list of alternatives Conflicting opinions among family members/significant others regarding action

to take Lack of/inadequate knowledge of community resources for care Fear of consequences of action, specifically:

Social consequences Economic consequences Physical consequences Emotional/psychological consequences

Negative attitude towards the health condition o problem – by negative attitude is meant one that interferes with rational decision making

Inaccessibility of appropriate resources for care, specifically: Physical inaccessibility Cost constraints or economic/financial inaccessibility

Lack of trust/confidence in the health personnel/agency Misconceptions or erroneous information about proposed course(s) of action Others, specify ______________________

o Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable /at-risk member of the family due to:

Lack of/inadequate knowledge about the disease/health condition (nature, severity, complications, prognosis and management);

Lack of/inadequate knowledge about child development and care Lack of/ inadequate knowledge of the nature and extent of nursing care needed Lack of the necessary facilities, equipment and supplies of care

Lack of or inadequate knowledge and skill in carrying out the necessary interventions/treatment/procedure/care (e.g. complex therapeutic regimen or healthy lifestyle program)

Inadequate family resources for care, specifically: Absence of responsible member Financial constraints Limitations/lack of physical resources –e.g. isolation room

Significant person’s unexpressed feelings (e.g., hostility/anger, guilt, fear/anxiety, despair, rejection) which disable his/her capacities to provide care.

Philosophy in life which negates/hinder caring for the sick, disabled, dependent, vulnerable/at-risk member

Member’s preoccupation with own concerns/interests Prolonged disease or disability progression which exhausts supportive capacity

of family members Altered role performance – specify:

Role denial o ambivalence Role strain Role dissatisfaction Role conflict Role confusion Role overload

Others, specify _________________________ o Inability to provide a home environment conducive to health maintenance and personal

development due to: Inadequate family resources, specifically:

Financial constraints/limited financial resources Limited physical resources – e.g. lack of space to construct facility

Failure to see benefits (specifically long-term ones of investment in home environment improvement

Lack of/inadequate knowledge of importance of hygiene and sanitation Lack of/inadequate knowledge of preventive measures Lack of skill in carrying out measures to improve home environment Effective communication patterns within the family Lack of supportive relationship among family members Negative attitude/philosophy in life which is not conducive to health

maintenance and personal development. Lack of/inadequate competencies in relating to each other for mutual growth

and maturation (e.g. reduced ability to meet the physical and psychological needs of other members as a result of family’s preoccupation with current problem or condition)

Others, specify ______________________ o Failure to utilize community resources for health care due to:

Lack of/inadequate knowledge of community resources for health care Failure to perceive the benefits of health care/services Lack of trust/confidence in the agency/personnel Previous unpleasant experience with health worker Fear of consequences of action (preventive, diagnostic, therapeutic

rehabilitative), specifically: Physical/psychological consequences Financial consequences Social consequences – e.g., loss of esteem of peer/significant others

Unavailability of required care/service Inaccessibility of required care/service due to:

Cost constraints Physical inaccessibility, i.e., location of facility

Lack of or inadequate family resources, specifically: Manpower resources – e.g. baby sitter Financial resources – e.g. cost of medicine prescribed

Feeling of alienation to/lack of support from the community, e.g., stigma due to mental illness, AIDS, etc.

Negative attitude/philosophy in life which hinders effective/maximum utilization of community resources for health care

Others, specify _________________________