HEALTH CARE PROCESS
Knowledge-based required for an adequate
- is a process utilized to systematize the helping
process extended to the clients
- basically it is the use of scientific method of
exploring and analysing data to arrive at
logical conclusions and rational solutions to
problems
PHASES OF HEALTH CARE PROCESS
I. ASSESSMENT
- Collection and analysis of factual information
relevant to client’s status, his capacity to
solve health problems and his environment
- The following are resources of data in
assessment:
A. HEALTH STATUS OF THE FAMILY
MEMBERS
1. Analyses of data taken from this source reflect
deviations in health development of
individuals.
2. Nurse needs adequate skills in determining
deviations in physical and psychosocial
aspects of a person’s health.
3. Broad knowledge based on the socio-cultural
variables affecting health, illness and
help-seeking behaviours.
B. FAMILY’S STRUCTURE AS A
FUNCTIONING UNIT EXPECTED TO
PROMOTE WELLNESS AMONG ITS MEMBERS
1. Analyses of data taken from this source reflect
the nature and extent of the family’s
performance of specific health tasks to meet the
physical, social and emotional
needs of its members.
2. Nurse needs knowledge on group processes,
family role relationships, and family
decision-making and family communication
patterns.
C. FAMILY ENVIRONMENT
1. Home and the community.
2.
assessment of physical and sociocultural threats
to health and development.
II. INTERVENTION
- This is where planning and putting plans to
actions are done
- The phase where the nurse formulates the
following:
a. Goals
b. Objectives
c. Nursing Actions
III. EVALUATION
- Done to demonstrate whether or not the
intended results did occur.
TWO TYPES OF DATA
1. FIRST LEVEL ASSESSMENT- content of the
initial data base.
2. SECOND LEVEL ASSESSMENT – reflects the
extent to which the family can perform the
health task on each health threat, health deficit
and stress point.
FAMILY HEALTH TASKS ACCORDING TO
FREEMAN
1. Recognizing interruptions of health
development- refers to the family’s ability to
recognize the
presence of a health problem.
2. Making decisions about taking appropriate
health actions.
3. Providing nursing care to the sick, disabled,
and/or dependent members of the family.
4. Maintaining a home environment conducive
to health maintenance and personal
development.
5. Maintaining a reciprocal relationship with the
community and its health institutions- implies
effective utilization of community resources for
health care.
METHODS OF GATHERING DATA
1. Direct observation
2. Interviewing
3. Other methods- include review existing
records and reports pertinent to the client.
e.g. clinical records of family members’
immunization
SEQUENCE OF ACTIVITIES IN FAMILY NURSING
PRACTICE
I. ESTABLISHES A WORKING RELATIONSHIP
WITH THE FAMILY
II. CONDUCTS AN INITIAL ASSESSMENT TO
DETERMINE THE PRESENCE OF
ANY HEALTH PROBLEM
III. CATEGORIZES HEALTH PROBLEMS
IV. DETERMINE THE NATURE AND EXTENT OF
THE FAMILY’S
PERFORMANCE OF THE HEALTH TASKS ON
EACH OF THE HEALTH
PROBLEMS CATEGORIZED IN NO.3
V. DETERMINE PRIORITIES AMONG THE LIST OF
HEALTH PROBLEMS
VI. RANK THE HEALTH PROBLEMS ACCORDING
TO PRIORITIES
VII. DECIDE ON WHAT PROBLEMS TO TACKLE IN
THE ORDER OR
IMMEDIACY/URGENCY, BASED ON PRIORITIES
SET
VIII. DEFINES NURSING OBJECTIVES (SMART)
JOINTLY WITH THE FAMILY
IX. PLANS APPROACHES, STRATEGIES OF
ACTION CRITERIA AND
STANDARDS FOR EVALUATION
X. IMPLEMENTS PLAN OF CARE
XI. EVALUATES THE EFFECTIVITY OF
IMPLEMENTED ASPECTS OF THE
PLAN
XII. REDEFINES NURSING PROBLES AND
REFORMULATES OBJECTIVES
ACCORING TO EVALUATION FINDINGS
SEQUENCE OF ACTIVIES IN FAMILY NURSING
PRACTICE
I. ESTABLISHES A WORKING RELATIONSHIP WITH
THE FAMILY
a. Initiates contact
b. Communicates interest in the family’s welfare
c. Express/show willingness to help with
expressed needs
d. Maintains a two-way communication with the
family
II. CONDUCTS AN INITIAL ASSESSMENT TO
DETERMINE THE PRESENCE OF
ANY HEALTH PROBLEM
TOOL: INITIAL DATA BASE (first level assessment
data)
INITIAL DATA BASE FOR FAMILY NURSING
PRACTICE
A. FAMILY STRUCTURE AND CHARACTERISTICS
1. Members of the household and relationship to
the head of the family
2. Demographic data- age, sex, civil status,
position in the family
3. Place of residence of each member- whether
living with family or
elsewhere
4. Type of family structure- matriarchal,
patriarchal, nuclear, extended
5. Dominant family members in terms of
decision-making in matters of
health care
6. General family relationship
B. SOCIO-ECONOMIC AND CULTURAL FACTORS
1. Income and expenses
a. Occupation, place of work and income of each
working member
b. Adequacy to meet basic necessities
c. Who makes decisions about the money and
how it is spent
2. Educational attainment of each member
3. Ethnic background and religious affiliation
4. Significant others
5. Relationship of the family to a larger
community
C. ENVIRONMENTAL FACTORS
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Adequacy of furniture
d. Presence of insects and rodents
e. Presence of accident hazards
f. Food Storage and cooking facilities
g. Water supply- source, ownership, potability
h. Toilet facility- type, sanitary condition
i. Garbage disposal- type, sanitary condition
j. Drainage system- type, sanitary condition
2. Kind of neighbourhood
3. Social and health facilities available
4. Communication and transportation facilities
available
D. HEALTH ASSESSMENT OF EACH MEMBER
1. Medical and Nursing history including past
significant illnesses, beliefs
and practices
2. Nutritional assessment
a. Anthropometric- height weight, mid-arm
circumference
b. Dietary history indicating quality and quantity
of food intake per day
c. Eating/feeding habits or practices
3. Current health status indicating presence of
illness state
E. VALUE PLACED ON PREVENTION OF DISEASE
1. Immunization status of children
2. Use of other preventive services
III. CATEGORIZES HEALTH PROBLEMS
TOOL: TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING
PRACTICE: FIRST LEVEL ASSESSMENT
A. HEALTH THREAT
-conditions that are conducive to disease,
accident or failure to realize one’s health
potential
1. Health history of specific condition/disease-
e.g. family history of diabetes
2. Threat of cross-infection from communicable
disease case
3. Family size beyond what family resources can
adequately provide
4. Accidental hazards
a. Broken stairs
b. Pointed or sharp objects, poisons, and
medicines improperly kept
c. Fire hazards
d. Fall hazards
5. Nutritional
a. Inadequate food intake both in quantity and
quality
b. Excessive intake of certain nutrients
c. Faulty eating habits
6. Stress-provoking factors
a. Strained marital relationships
b. Strained parent-sibling relationship
c. Interpersonal conflicts between family
members
7. Poor environmental sanitation
a. Inadequate living space
b. Inadequate personal belonging/utensils
c. Lack of food storage facilities
d. Polluted water supply C. FORSEEABLE CRISIS OR STRESS POINTS
e. Presence of breeding places of insects and - Anticipated periods of unusual demand on the
rodents individual or family in terms of
f. Improper garbage/refuse disposal adjustment/family resources
g. Unsanitary waste disposal 1. Marriage
h. Improper drainage system 2. Pregnancy, labor
i. Poor lighting and ventilation 3. Parenthood
j. Noise pollution 4. Additional member- e.g. new born, lodger
k. Air pollution 5. Abortion
8. Unsanitary food handling and preparation 6. Entrance at school
9. Personal habits/practices 7. Adolescence
a. Frequent drinking alcohol 8. Loss of job
b. Excessive smoking 9. Death of a member
c. Walking barefooted 10. Resettlement in a new community
d. Eating raw meat/fish 11. Illegitimacy
e. Poor personal hygiene 12. Others, specify
f. Self-medication
g. Use of dangerous drugs/narcotics IV. DETERMINE THE NATURE AND EXTENT OF
h. Sexual promiscuity THE FAMILY’S
i. Engaging in dangerous sports PERFORMANCE OF THE HEALTH TASKS ON
10. Inherent personal characteristics- e.g. short EACH OF THE HEALTH
temper PROBLEMS CATEGORIZED IN NO.3
11. Health history which may precipitate/induce
the occurrence of a health deficite.g. previous TOOL: TYPOLOGY OF NURSING PROBLEMS IN
history of difficult labor FAMILY NURSING
12. Inappropriate role assumption
13. Lack of immunization/inadequate PRACTICE: SECOND LEVEL ASSESSMENT
immunization status specially of children
14. Family disunity I. INABILITY TO RECOOGNIZE THE PRESENCE OF
15. Others, specify A PROBLEM DUE
TO:
A. Ignorance of facts
B. Fear of consequences of diagnosis of problem
B. HEALTH DEFICIT 1. Social stigma loss of respect of
-instances of failure in health maintenance peer/significant others
1. Illness states regardless whether it is 2. Economic cost
diagnosed or underdiagnosed by medical 3. Physical/psychological
practitioner. C. Attitude/Philosophy
2. Failure to thrive/develop according to normal D. Others, specify
rate
3. Disability arising from illness, whether II. INABILITY TO MAKE DECISIONS WITH RESPECT
transient/temporary TO TAKING
-e.g. paralysis, leg amputation, blindness, and APPROPRIATE HEALTH ACTION DUE TO:
lameness
A. Failure to comprehend the nature,
magnitude/scope of the problem
B. Low salience of the problem
C. Feeling of confusion and/or resignation
brought about by failure to break
down problems into manageable units of attack
D. Lack of knowledge/insight as to alternative
courses of action open to them
E. Inability to decide which action to take from
among a list of alternatives
F. Conflicting opinions among family members or
significant others regarding
action to take
G. Ignorance of community resource for care
H. Fear of consequences of action
I. Negative attitude towards the health problem-
by negative attitude is meant
one that interfere as with rational decision-
making
J. Inaccessibility of appropriate q of care
K. Lack of trust/confidence in the health
personnel or agency
L. Misconceptions or erroneous information
about proposed courses of action
M. Others, specify
III. INABILITY TO PROVIDE ADEQUATE NURSING
CARE TO THE SICK,
DISABLED, DEPENDENT OR VULNERABLE OR AT
RISK MEMENER
OF THE FAMILY DUE TO:
A. Ignorance of facts about the disease or health
condition (nature, severity,
complications, prognosis, and management);
child development and child
care
B. Ignorance of the nature and extent of nursing
care needed
C. Lack of the necessary facilities ( equipment
and supplies ) for care
D. Lack knowledge and skill in carrying out the
necessary
treatment/procedure/care
E. Inadequate family resources of care
F. Negative attitude towards the sick, disabled,
dependent, vulnerable
G. Attitude/philosophy in life
H. Member’s preoccupation with own
concerns/interests
I. Others, specify
IV. INABILITY TO PROVIDE A HOME
ENVIRONMENT WHICH IS
CONDUCIVE TO HEALTH MAINTENANCE AND
PERSONAL
DEVELOPMENT DUE TO:
A. Inadequate family resources
B. Failure to see benefits (specially long-term
ones) of investment in home
environment improvement
C. Ignorance of importance of hygiene and
sanitation
D. Ignorance of preventive measures
E. Lack of skill in carrying out measures to
improve home environment
F. Ineffective communication patterns
G. Attitude/philosophy in life
H. Others, specify
V. FAILURE TO UTILIZE COMMUNITY RESOURCES
FOR HEALTH
CARE DUE TO:
A. Ignorance or lack of awareness of community
resources for health care
B. Failure to perceive the benefits of health care
or services
C. Lack of trust or confidence in the agency or
personnel
D. Previous unpleasant experience with health
worker
E. Fear of consequences of action
F. Unavailability of required care/service
G. Inaccessibility of required care/service
H. Lack or inadequate family resources
I. Feeling of alienation of lack of support from
the community
J. Attitude/philosophy in life
K. Others, specify
V. DETERMINE PRIORITIES AMONG THE LIST OF
HEALTH PROBLEMS
TOOL: SCALE FOR RANKING FAMILY HEALTH
PROBLEMS ACCORDING TO
PRIORITIES
A. NATURE OF THE PROBLEM
- categorizes the problem as health threat,
health deficit, or stress points
B. MODIFIABILITY OF THE PROBLEM
- Refers to the probability of success in
minimizing, alleviating or totally eradicating the
problem through nursing intervention
1. Current knowledge, technology, and
interventions to manage the problem
2. Resources of the family- physical, financial and
manpower
3. Resources of the nurse- knowledge, skills and
time
4. Resources of the community- facilities and
community organization or support
C. PREVENTIVE POTENTIAL OF THE PROBLEM
- Refers to the nature and magnitude of future
problems that can be minimized or totally
prevented if intervention is done on the problem
under consideration
1. Gravity or severity of the problem
2. Duration of the problem
3. Current management
4. Exposure of any high risk group
D. SALIENCE OR FAMILY’S PERCEPTION/
EVALUATION OF EACH PROBLE IN
TERMS OF SERIOUSNESS AND URGENCY BASED
ON PRIORITIES SET
VI. RANK THE HEALTH PROBLEMS ACCORDING
TO PRIORITIES
VII. DECIDE ON WHAT PROBLEMS TO TACKLE IN
THE ORDER OF
IMMEDIACY/URGENCT, BASED ON PRIORITIES
SET
VIII. DEFINES NURSING OBJECTIVES (SMART)
JOINTLY WITH THE FAMILY
IX. PLANS APPROACHES, STRATEGIES OF ACTION
CRITERIA AND STANDARDS
FOR EVALUATION
X. IMPLEMENTS THE PLAN OF CARE
XI. EVALUATES THE EFFECTIVITY OF
IMPLEMENTED ASPECTS OF THE PLAN
XII. REDEFINES NURSING PROBLEMS AND
REFORMULATES OBJECTVES
ACCORDING TO EVALUATION FINDINGS
FORMAT OF THE FAMIL NURSING CAREP PLAN
1. Health problem
2. Family nursing problems
3. Goals of care
4. Objectives of care
5. Intervention measures
6. Method of Nurse-Family Contact
7. Resources Required
8. Evaluation
COMPONENTS
1. HEALTH PROBLEM
- A situation or condition which interferes with
the promotion and/or maintenance of health
and recovery from illnesses and injury
2. FAMILY NURSING PROBLEMS
- A health problem becomes a nursing problem
when it can be modified through nursing
interventions
3. GOALS OF CARE
- General statements of purpose
- The end towards which all efforts are directed
- Broadly state
- Not measurable
4. OBJECTIVES OF CARE
- are more specific statements of the desired
results of outcome after giving the nursing
intervention
5. INTERVENTION MEASURES
- Refers to the expected behaviours that the
nurse will perform with the patient must be
taken for a source and must have a footnote at
the end of each intervention.