Nursing Assessment in

Nursing Practice

By: Michelle E. Manahan

Family Health Practice guidelines

• Family Nursing : is a kind of nursing practice in

which the family is the unit of services.
• Not merely family oriented
• Holistic approach
 Five principle guide and enhance family
nursing practice
1. Work with the family collectively

 Set aside usual focus on individual

 View the family as one unit
 Community health nurses want to involve all of the
family during nurse-client interaction.
 Encourage everyone’s participation.
2. Start where the family is

 Begin at the present level of functioning

 Conduct a family assessment to ascertain the members
needs and level of health
 Determine collective interests, concerns and proprieties
3. Adapt nursing intervention to the family’s stage of
development :

 Awareness of family’s developmental stage enables the nurse to

assess the appropriateness of the family’s level of functioning
and to tailor intervention accordingly.
4. Recognize the validity of family structural variations:

 Two important principles to remember :

I. What is normal for one family is not necessarily normal
for another .
II. Families are constantly changing.
5. Emphasize family strengths
 Too often, nurse focus on family weaknesses ( Negative emphasis )
this is not truly therapeutic.
 Families need their strength reinforced .
 Emphasizing a family strength makes people feel better about
themselves.
 The nurse lists positive points about an otherwise negative
situation.
 Family Health Assessment:
• To assess a family’s level in a systematic three tools are
needed :
1. A conceptual framework on which to base the
assessment.
2. A clearly defined set of assessment categories for data
collection.
3. A method for measuring family’s level of functioning.
 Family Health Care Process
• DATA COLLECTION: METHODS AND TOOLS
• DATA ANALYSIS or INTERPRETATION
• PLANNING
• IMPLEMENTATION
• EVALUATION PHASE
 ASSESSMENT PHASE
• first major phase of nursing process in family health nursing
• Involves a set of action by which the nurse measures the status of
the family as a client. Its ability to maintain wellness , prevent,
control or resolve problems in order to achieve health and
wellness among its members
• Data about present condition or status of the family are
compared against the norms and standards of personal , social,
and environmental health, system integrity and ability to resolve
social problems.
• The norms and standards are derived from values, beliefs,
principles, rules or expectation.
 TWO MAJOR TYPES

• FIRST LEVEL ASSESSMENT- a process whereby existing and potential

health conditions or problems of the family are determined (WS, HT,
HD, SP or FC)

• SECOND LEVEL ASSESSMENT- defines the nature or type of nursing

problem that family encounters in performing health task with
respect to given health condition or problem and etiology or
barriers to the family’s assumption of the task
DATA COLLECTION METHODS: SELECT APPROPRIATE
METHOD
•OBSERVATION
• done through use of sensory capacities
• The nurse gathers information about the family’s state of being and
behavioral responses
• the family’s health status can be inferred from the s/sx of problem areas
• a. communication and interaction patterns expected ,used, and
tolerated by family members
• b. role perception / task assumption by each member including
decision making patterns
• c. conditions in the home and environment

** Data gathered though this method have the advantage of being

subjected to validation and reliability testing by other observers
•PHYSICAL EXAMINATION

• significant data about the health status of individual members

can be obtained through direct examination through IPPA,
Measurement of specific body parts and reviewing the body
systems
• data gathered from P.A form substantive part of first level
assessment which may indicate presence of health deficits
(illness state )
•INTERVIEW

• Productivity of interview process depends upon the use

effective communication techniques to elicit needed response

PROBLEMS ENCOUNTERED:
• How to ascertain where the client is in terms of perception of
health condition or problems and the patterns of coping
utilized to resolve them
• Tendency of community health worker to readily give out
advice, health teachings or solutions once they have
identified the health condition or problems.
• Provisions of models for phrasing interview questions
utilization of deliberately chosen communication techniques
for an adequate nursing assessment.
• confidence in the use of communication skills
• Being familiar with and being competent in the use of type of
question that aim to explore, validate, clarify, offer feedback,
encourage verbalization of thought and feelings and offer
needed support or reassurance.
 TYPES:
1. Completing health history of each family member
1.Health history determines current health status based on
significant PAST HEALTH HISTORY e.g. developmental
accomplishment, known illnesses, allergies, restorative treatment,
residence in endemic areas for certain diseases or sources of
communicable diseases.
2.FAMILY HISTORY e.g. genetic history in relation to health and
illness.
3.SOCIAL HISTORY e.g. intra-personal and inter-personal factors
affecting the family member social adjustment or vulnerability to
stress and crisis
2. Collecting data by personally asking significant family members or relatives
questions regarding health, family life experiences and home environment to
generate data on what wellness condition and health problem exist in the family
( first level assessment) and the corresponding nursing problems for each
health condition or problem ( 2nd level assessment)
•RECORDS REVIEW
• Gather information through reviewing existing records and reports
pertinent to the client
• Individual clinical records of the family members, laboratory and
diagnostic reports, immunization records reports about home and
environmental conditions
•LABORATORY/ DIAGNOSTIC TEST
ANALYZE DATA TO IDENTIFY NEEDS AND
PROBLEMS
1.CRITERIA FOR ANALYSIS:
2.PROCESS FOR ANALYSIS:
1.SORTING OF DATA
2.CLUSTERING OF RELATED CUES
3.DISTINGUISHING RELEVANT FROM IRRELEVANT
CUES
4.IDENTIFYING PATTERNS
5.COMPARING PATTERNS
6.INTERPRETING RESULTS OF COMPARISON
7.MAKING INFERENCES AND DRAWING CONCLUSIONS
 Health Needs and Problems of the
Family
•A situation which interferes with the promotion and /
or maintenance of health

•It is a health problem when it stated as the family’s

failure to perform adequately specific health task to
enhance the wellness state or manage a health
problem
Family Health Assessment:
1. Conceptual Framework : is a set of concepts
integrated into a meaning explanation that helps one
interpret human behavior or situation.
 Three framework that are particularly useful in
community health nursing :
A. The interactional framework.
B. The structural-functional framework.
C. The developmental framework.
1. Conceptual Framework
A. The Interactional framework: describes the family as a unit of
interacting personalities and emphasize communication, roles,
conflict, coping pattern, and decision making process.

 This framework focuses on the internal relationships but

neglect the family interaction with the external environment .
B. The structural framework describes the family as a social
system relating to other social system in the external
environment.

 This framework examine the interacting functions of

society and the family (External), consider family structure
and analyze how a family’s structure affects its function .
C. The developmental framework studies families from a lifecycle
perspective by examining members’ changing roles and tasks in
each progressive life-cycle stage.
 This framework incorporate elements from interactional and
structural-functional approaches so that family structure function,
and interaction are viewed in the context of the environment at
each stage of family development .
2. Data collection categories:
• There are 12 categories :
1. Family demography .
2. Physical environment .
3. Psychological and spiritual environment.
4. Family structure and roles.
5. Family function.
6. Family values and beliefs.
7. Family communication pattern
8. Family decision-making patterns
9. Family problem solving patterns
10. Family coping pattern
11. Family health behavior
12. Family social and cultural patterns.
3. Assessment Method:
• Three well-known graphic assessment tools are :

1. Eco-map: is a diagram of the connection between the family

and the other system in its ecologic environment.
2. The genogram : displays family information graphically in a way that
provides a quick view of complex family pattern.
3. Social network support map ( Grid ):gives details about the
quality of social connection.
Guide lines for family health assessment :

1. Focus on the family as total unit.

2. Ask goal-directed questions.
3. Collect data over time.
4. Combine quantitative and qualitative.
5. Exercise professional judgment.
 Family care plan:

• Family assessment and planning instrument :

This is an assessment and planning instrument to help
you to organize your data . Its not be taken into a home
as an interviewing instrument.
Family and care plan:
FAMILY ROLE-RELATIONSHIP PATTERN :
• Initial of family ________
• surname ________
Persons living in the house hold
• Given name only: ________
• Date of birth: ________
• Age : ________
• Sex: ________
• Relation to head of Household: ________
• Occupation: ________
FAMILY ROLE-RELATIONSHIP PATTERN :
• Identify primary care giver : ________
• Members of family not living in household :
• Significant others : ________
• Pets : ________
• Occupation history of each adult member ( Past/Present ) : ________
• Job Identification : ________
• Exposure to health hazards : ________
• Family dynamics : ________
Communication pattern :
• Expression of feelings ( happiness , sadness , fear , anger … )
• Verbal and non-verbal :
• How are message transmitted ?
Social relations
• Who do the family members interact with outside the immediate family ,
and what community activities do they participate in ?
• Extend family ________ , Neighbors ________ .
• Friends ________ , Mosques ________ , Clubs ________ .
• Community activities ( list ) ________ .
Income
• Family income : ________ .
• Source : salary ________ , saving ________ , investment ________ .
• Others ________ .
• Contribution of working members :
• Member : ________ , Amount : ________ (JD, $ & SH )
• Are expenses greater , less than or equal to income : ________
• Who plans how the money is spent ?
1. FAMILY COGNITIVE / PERCEPTION PATTERN :
• Educational level , What is the highest grade completed ?
• Adults : ________ Children : ________
• Members of the family with learning or developmental disabilities ?
• Decision making : Who make the decisions ? Give examples :
2. FAMILY SELF PERCEPTION / SELF CONCEPT PATTERN :
• Family's perception of their ability to maintain their family unit :
• Family's pride in their home :
Family residence :
• Type : Single : ________ ,
Multifamily : ________ ,
Own : ________ , Rent : ________ Describe
condition of home inside and outside :
• Number of rooms : ________
• Space : Adequate : ________, Inadequate : ________
• Furniture : Adequate : ________ , Inadequate : ________
• Accident hazards : ________
• Neighborhood : ________
• Residential : ________ . Industrial : ________ . Rural : ________ .
• Urban : ________ . Suburban : ________. Other : ________ .
• Condition of dwellings and streets :
Accessibility of :
• Play area : Yes ________ . No ________
• Health facilities ( List ) : Yes ________ . No________
• Mosques , Churches : Yes________ . No ________
• Schools : Yes ________ . No ________
• Public transportation ? Type ? ________
• Family's method of transportation :________
• Neighborhood health hazard : ________
• Family's perception of safety in the neighborhood ?
3. FAMILY NUTRTIONAL-METABOLIC PATTERN :
• Observation about kitchen and mealtimes :
• Who does the grocery shopping ?
• Who does the cooking ?
• Therapeutic diets :
• Observation of family member of nutritional 24-hrs food/fluid
intake : Break fast , Lunch , Dinner , Snacks
• Analyze if diet provides nutrients ?
• How is food stored ?
• Water supply :Municipal , Well , Other.
4. FAMILY ELIMINATION PATTERN :
• Compliance with garbage regulations ?
Yes ________ . No ________ . If no , explain ?
• Rodents ?
Yes ________ . No ________ .
• Insects ?
Yes ________ . No ________ .
• Toilet facilities ?
Yes ________ . No ________ .
5. FAMILY ACTIVITY-EXERCISE PATTERN :
• Adults leisure ________ . Children leisure ________ .
• Shared family activities ________ .
• Type of activities required for family roles : ________________ .
Adults : ________ . Children : ________ .
• Describe pace of family life :
Fast : ________. Moderate : ________ . Slow : ________.
6. FAMILY ACTIVITY SLEEP-REST PATTERN :
• Which family member sleep alone ?
• What type of bed does each have ?
• What are the usual hours of sleep ?
• Bedtime , arising , rest periods for adult and children ?
• Are they any disturbances in family sleep pattern ?
7. FAMILY SEXUALITY-REPRODUCTION PATTERN :
• Sexual relationships :
• Family planning :
• Sex education of children :
8. FAMILY VALUE AND BELIEF PATTERN ?
• Ethnic background ________ . Influence on health behavior .
• Religious affiliation ________ . Degree of family involvement
________ .
• Influences on health behavior :
• Family's definition of health :
• Health beliefs and attitudes :
• Folk medicine :
• Use of non-traditional healing methods :
• Acceptance / non-acceptance of help from community
agencies ?
9. FAMILY COPING STRESS TOLERANCE PATTERN :
• How has the family managed in previous situation of illness or
crises ?
• Own resources ________ . Extended family : ________ .
• Other relatives ________ . Friends ________ . Neighborhood
________ .
• Significant others ________ . Health professional ________. Other
________ .
• Caregiver's perception of their ability to deal with crises :
• Client perception of caregiver's / family ability to deal with
demands of care :
10. FAMILY HEALTH PERCEPTION HEALTH MANAGEMENT PATTERN :
• Reason for visit :
• Family's perception of their level of health :
• Medical diagnosis of each family member :
• Familial disease ( heart , cancer , stroke , anemia , ….. etc )
• History of past significant illness and accident of each family
member :
• Risk factors ( tobacco , alcohol , obesity , lack exercise ) :
Family health practice :
• Immunization status of each family member :
• Self exam ( breast , testicular , ….. etc )
• Preventive exams ( dental , colon/rectal ) :
• Names of physician / date of last appointment and next
scheduled appointment for each family member :
• Medication : is any family member taken any medication ?
Yes: ------. No : ------ .
• If yes ( including over the counter drugs ) :
Name of the drug _______ .How often taken : ______.
Drug action ________ .Side effects : ________ .
Date of prescription : ________ .Number of refills : ___
.
Physician : ________ .Pharmacist : ________ .
• Treatment prescribed for family members :
• Level of compliance with prescribed medication and
treatments :
Financing health care :
• Health insurances : ________ .
• Private insurances : ________ .
• Own finance : ________ .
Examples for family nursing diagnosis:
• Family Processes, Dysfunctional: Alcoholism ( substance
abuse ).
• Family Processes, Interrupted.
• Family Processes, Readiness for Enhanced.
• Family coping, ineffective.
• Family coping, potential for growth.
Examples for family nursing diasis:
• Parental role conflict.
• Parent/infant/child attachment, altered, risk for.
• Parenting, altered.
• Parenting, altered, risk for.
• Role performance, altered
• Social interaction, impaired.
• Social isolation.
ASSESSMENT PHASE
DATA ANALYSIS HEALTH CONDIITONS/
DATA COLLECTION PROBLEMS AND FAMILY
NURSING DIAGNOSIS
Framework: Use an Organized
Sort Data - First Level Assessment:
and Comprehensive Approach (Define the health
to Assessment Cluster/Group Related - conditions, health deficit,
Data health threats, foreseeable
First Level: Data on crisis or stress points)
Distinguish Relevant -
Status/condition:
form irrelevant data Second Level Assessment
Family, Household Members, Identify patterns - Define the family nursing
Home and (function, behaviour, - problems/diagnosis (Table
3)
Environment lifestyle)
Compare patterns with - Family’s Inability to
Second Level: Data on family’s perform health tasks on
norms or standards
assumption of health task on each health
each health condition/problem Interpret result - condition/problem
specifying the barriers to
identified in first level Make inferences/ draw - performance or reasons for
assessment. conclusions non-performance of family
health tasks
Cont.. METHODS/ SOURCES
First Level Assessment
(Table 2)
Health status of the
family/household members
-Health Assessment
-Laboratory/Diagnostic Test Result
Records/Repo
Home and Environment
-Observation/Occular
Survey
- -Interview
- -lab/Dx Test
- -Records/Report
Cont..
SECOND LEVEL
ASSESSMENT
- - In depth interview on
realities/perceptions
about and attitude
towards assumption/
performance of health
task.
- - observation: Relate
verbal and non-verbal
cues
Nature of the problem
• As categorized
Modifiability of the problem
• Refers to the probability of success in enhancing the wellness
state, improving the condition, minimizing, alleviating or totally
eradicating the problem through intervention.
Preventive potential
• Refers to the nature of magnitude of future problems that can be
minimized or totally prevented if intervention is done on the
condition or problem under consideration.
Salience
• Refers to the family’s perception and evaluation of the condition or
problems in terms of seriousness and urgency of attention needed of
family readiness
NATURE OR CATEGORIES OF HEALTH PROBLEM
1. 1. Health threat- conditions that are conducive to disease, accident or
failure to realize one’s potential.
- Does it promote disease or prevent people from realizing their
health potential.
- family history of hereditary disease
- threat of cross infection
- accident hazards
- faulty eating habits
- poor environmental sanitation
- unhealthy lifestyle
2. Health Deficit- when there is a gap between actual and achievable
heath status which may be due to failures in health maintenance.
- illness states, diagnosed or undiagnosed.
- failure to thrive/develop
- disability
- transient/permanent conditions
3. Foreseeable crisis- anticipated periods of unusual demand on the
individual or family in terms off adjustment/family resources.
- situational
- marriage, pregnancy, parenthood
- divorce, separation
- loss of job, menopause
- death.
 MAGNITUDE OF THE PROBLEM

This refers to the percentage of the population that has

been affected and may be categorized as follows:
• 75-100% affected - 4pts
• 50-74% affected- 3 pts
• 25-49% affected- 2 pts
• Less than 25% affected- 1 pt
 MODIFIABILITY OF THE PROBLEM
This refers to the probability of success in minimizing,
alleviating or totally eradicating the problem through
interventions.
• Easily modifiable- 2 pt
• Partially modifiable- 1pt
• Not modifiable- 0 pt
 PREVENTIVE POTENTIAL
This refers to the nature and magnitude of future problems that can be
minimized to totally prevented if intervention is done on the problem
under consideration. It is capability of stopping or avoiding the
occurrence of the problem?

• High 3pts
• Moderate 2 pts
• Low 1 1 pt
 SALIENCE OR SOCIAL CONCERN
This refers to community’s perception and evaluation of
the problem in terms of seriousness and urgency of
attention needed.
• A serious problem, immediate attention needed - 2pts
• A problem, but not needing immediate attention -1 pt
• Not a felt need/problem -0 pt.