FAMILY HEALTH NURSING

 INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. FAMILY STRUCTURE & CHARACTERISTICS

1. Members of the household & 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: patriarchal, matriarchal, nuclear, extended
5. Dominant family members in terms of decision making in matters of health
care
6. General family relationship – presence of any obvious/readily observable
conflict between members; characteristic communication patterns among
members

B. SOCIO-ECONOMIC & CULTURAL FACTORS

1. Income & Expenses
a. Occupation, place of work & income of each working member
b. Adequacy to meet basic necessities (food, clothing, shelter)
c. Who makes decisions about the money & how is it spent?
2. Educational attainment of each member
3. Ethnic background & religious affiliation
4. Significant others: roles they play in the family’s life
5. Relationship of the family to larger community – what is the participation of
the family in community activities?

C. ENVIRONMENTAL FACTORS
1. Housing
a. Adequacy of living space
b. Sleeping arrangement
c. Adequacy of the furniture
d. Presence of insects & rodents
e. Presence of accident hazards
f. Food storage & cooking facilities
g. Water supply – source, ownership, potability
h. Toilet facility – type, ownership, sanitary condition
i. Garbage/refuse disposal – type, sanitary condition
j. Drainage system – type, sanitary condition
2. Kind of neighborhood
3. Social & health facilities available
4. Communication & transportation facilities available

D. HEALTH ASSESSMENT OF EACH MEMBER

1. Medical & nursing history indicating past significant illnesses, beliefs &
practices conducive to illness
2. Nutritional assessment (especially for vulnerable or at risk member)
a. Anthropometric data – weight, height, mi-upper arm circumference
b. Dietary history indicating quality & quantity of food intake per day
c. Eating/feeding habits/practices
3. Current health status indicating presence of illness (diagnosed or undiagnosed
by medical practitioner)

E. VALUE PLACED ON PREVENTION OF DISEASE

1. Immunization status of children
2. Use of other preventive services
 TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING
PRACTICE

A. FIRST LEVEL ASSESSMENT

Look out for presence of health threats, health deficits & foreseeable crisis or
stress points in the family

1. HEALTH THREATS – conditions that are conducive to disease, accident or

failure to realize one’s health potential
Examples:
a.Health history of specific conditions/disease (e.g. family history of DM)
b. Threat of cross infection from communicable disease case
c.Family size beyond what family resources can adequately provide
d. Accident hazards (broken stairs, pointed/sharp objects, poisons & medicines
improperly kept)
e.Nutritional (inadequate food intake both in quantity & quality; excessive
intake of certain nutrients; faulty eating habits, unsanitary food handling &
preparation)
f. Stress-provoking factors (strained marital relationship, strained parent-sibling
relationship, interpersonal conflicts between family members)
g. Poor environmental sanitation
• Inadequate living space
• Inadequate personal belongings/utensils
• Lack of food storage facilities
• Polluted water supply
• Presence of breeding places of insects & rodents
• Improper garbage/refuse disposal
• Unsanitary waste disposal
• Improper drainage system
• Poor lighting & ventilation
• Noise pollution
• Air pollution
h. Personal habits/practices
• Frequent drinking of alcohol
• Excessive smoking
• Walking barefooted
• Eating raw meat/fish
• Poor personal hygiene
• Self-medication
• Use of dangerous drugs/narcotics
• Sexual promiscuity
• Engaging in dangerous sports
i. Inherent personal characteristics (ex. short temper)
j. Inappropriate role assumption
k. Health history which may precipitate/induce the occurrence of a health
deficit (ex. previous history of difficult labor)
l. Lack of immunization/inadequate immunization status especially of children

2. HEALTH DEFICITS – instances of failure in health maintenance

Examples:
a. Illness states; regardless whether it is diagnosed or undiagnosed by medical
practitioner
b. Failure to thrive/develop according to normal rate
c. Disability arising from illness, whether transient/temporary (ex. aphasia or
temporary paralysis after a CVA) or permanent (e. leg amputation secondary
to DM; blindness from measles; lameness from polio)

3. STRESS POINTS/FORESEEABLE CRISIS – anticipated periods of unusual

demand on the individual or family in terms of adjustment/family resources
Examples:
 a.Marriage
b. Pregnancy, labor, puerperium
c.Parenthood
d. Additional member (newborn, lodger)
e.Abortion
f. Entrance at school
g. Loss of job
h. Death of a member
i. Resettlement in a new community
j. Illegitimacy

B. SECOND LEVEL ASSESSMENT

1. INABILITY TO RECOGNIZE THE PRESENCE OF A PROBLEM DUE

TO:
a. Ignorance of facts
b. Fear of consequences of diagnosis of problem (ex. social stigma, loss of
respect of peer & significant others, economic cost, physical/psychological
consequences)
c. Attitude or philosophy in life

2. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING

APPROPRIATE HEALTH ACTION DUE TO:
a. Failure to comprehend the nature, magnitude/scope of the problem
b. Low salience of the problem
c. Feeling of confusion &/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/significant others regarding
action to take
g. Ignorance of community resources for care
h. Fear of consequences of action (ex. social, economic, physical/psychological)
i. Negative attitude towards the health problem (one that interferes with rational
decision making)
j. Inaccessibility of appropriate resources of care (physical – location; cost)
k. Lack of trust/confidence in the health personnel/agency
l. Misconceptions or erroneous information about proposed course(s) of action

3. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THE

SICK, DISABLED OR VULNERABLE/AT RISK MEMBER OF THE
FAMILY DUE TO:
a. Ignorance of facts about the disease/health condition (nature of severity,
complications, prognosis & management); child development & child care
b. Ignorance of the nature & extent of nursing care needed
c. Lack of the necessary facilities (equipment & supplies) for care
d. Lack of knowledge & skill in carrying out the necessary
treatment/procedure/care
e. Inadequate family resources for care (responsible member, financial, physical
resources – ex. isolation room)
f. Negative attitude towards the sick, disables, dependent, vulnerable/at risk
member
g. Attitude/philosophy in life
h. Members’ preoccupation with own concerns/interests

4. INABILITY TO PROVIDE A HOME ENVIRONMENT WHICH IS

CONDUCIVE TO HEALTH MAINTENANCE & PERSONAL
DEVELOPMENT DUE TO:
a. Inadequate family resources (financial, physical – lack of space to construct
facility)
b. Failure to see benefits (especially long term ones) of investment in home
environment improvement
 c. Ignorance of importance of hygiene & 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

5. 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/services
c. Lack of trust/confidence in the agency/personnel
d. Previous unpleasant experience with health worker
e. Fear of consequences of action (preventive, diagnostic, therapeutic,
rehabilitative) – physical/psychological, financial, social (ex. loss of self-
esteem of peer/significant others)
f. Unavailability of required care/service
g. Inaccessibility of required care/service (cost, physical location)
h. Lack of or inadequate family resources (manpower – ex. baby sitter; financial
– ex. cost of medicine prescribed)
i. Feeling of alienation to/lack of support from the community (ex. mental
illness)
j. Attitude or philosophy in life

 SCALE FOR RANKING FAMILY HEALTH PROBLEMS ACCORDING

TO PRIORITIES

CRITERIA WEIGHT

1. Nature of the problem presented 1

Health Threat 2
Health Deficit 3
Foreseeable Crisis 1
2. Modifiability of the problem 2
Easily Modifiable 2
Partially Modifiable 1
Not Modifiable 0
3. Preventive potential 1
High 3
Moderate 2
Low 1
4. Saliency 1
A serious problem; immediate attention needed 2
A problem but not needing immediate attention 1
Not a felt need/problem 0

SCORING:
1. Decide on a score for each of the criteria
2. Divide the score by the highest possible score & multiply by the weight
3. Sum up the scores for all the criteria. The highest score is 5 equivalent to the total
weight.