FAMILY AND COMMUNITY ASSESSMENT

Family Nursing Process

 involves a set of actions by which the nurse measures the status of the family as a client, its ability to maintain itself as a system and functioning unit, its ability to maintain wellness, prevent, control or resolve problems in order to achieve health and well-being among its members.

Initial Data base

a.) family structure, characteristics & dynamics include the composition and demographic data of the members of the family/household, their relationship to the head and place of residence; the type of, and family interaction/communication and decision-making patterns and dynamics.

b.) socio-economic & cultural characteristics include occupation, place of work, and income of each working member; educational attainment of each family member; ethnic background and religious affiliation; significant others and the other role(s) they play in the familys life; and, the relationship of the family to the larger community.

c.) home and environment include information on housing and sanitation facilities; kind of neighborhood and availability of social, health, communication and transportation facilities in the community.

d.)health status of each member includes current and past significant illness; beliefs and practices conducive to health and illness; nutritional and developmental status; physical assessment findings and significant results of laboratory/diagnostic tests/screening procedures.

e.) values and practices on health promotion/maintenance & disease prevention include use of preventive services; adequacy of rest/sleep, exercise, relaxation activities, stress management or other healthy lifestyle activities, and immunization status of atrisk family members.

FIRST- LEVEL ASSESSMENT

I. 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 one II. PRESENCE OF HEALTH THREATS conditions that are conducive to disease and accident, or may result to failure to maintain wellness or realize health potential. III. PRESENCE OF HEALTH DEFICITS instances of failure in health maintenance.

IV. PRESENCE OF STRESS POINTS/FORESEEABLE CRISIS SITUATIONS anticipated periods of unusual demand on the individual or family in terms of adjustment/family resources.

SECOND-LEVEL ASSESSMENT
I. Inability to recognize the presence of the condition or problem. II. Inability to make decisions with respect to taking appropriate health action.

III. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at-risk member of the family.
IV. Inability to provide a home environment conducive to health maintenance and personal development. V. Failure to utilize community resources for health care.

Problem Prioritization
Nature of the Problem Wellness condition Health deficits Health threats Foreseeable crisis Preventive Potential 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

Modifiability of the Condition refers to the probability of success in enhancing the wellness state, improving the condition, minimizing, alleviating or totally eradicating the problem through intervention Salience refers to the familys perception and evaluation of the problems in terms of seriousness and urgency of attention needed

Scale for Ranking Health Conditions and Problems according to Priorities

Criteria Nature of the Condition Wellness State Health Deficit Health Threat Foreseeable Crisis 3 3 2 1 1 Score Weight

Modifiability of the Condition

Easily Modifiable Partially Modifiable Not Modifiable Preventive Potential High Moderate Low Salience A condition needing immediate attention A condition not needing immediate attention Not perceived as a condition needing change 2 1 0 2 2 1 1 2 1 0 1

DEVELOPING THE NURSING CARE PLAN

THE FAMILY CARE PLAN is the blueprint of the care that the nurse designs to systematically minimize or eliminate the identified health and family nursing problems through explicitly formulated outcomes of care ( goals and objectives) and deliberately chosen of interventions, resources and evaluation criteria, standards, methods and tools.

DESIRABLE QUALITIES OF A NURSING CARE PLAN

It should be based on clear, explicit definition of the problems. A good nursing plan is based on a comprehensive analysis of the problem situation. A good plan is realistic. The nursing care plan is prepared jointly with the family. The nurse involves the family in determining health needs and problems, in establishing priorities, in selecting appropriate courses of action, implementing them and evaluating outcomes. The nursing care plan is most useful in written form.

THE IMPORTANCE OF PLANNING CARE

They individualize care to clients. The nursing care plan helps in setting priorities by providing information about the client as well as the nature of his problems. The nursing care plan promotes systematic communication among those involved in the health care effort. Continuity of care is facilitated through the use of nursing care plans. Gaps and duplications in the services provided are minimized, if not totally eliminated. Nursing care plans, facilitate the coordination of care by making known to other members of the health team what the nurse is doing.

STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

The prioritized condition/s or problems based on: nature of condition or problem modifiability preventive potential salience The goals and objectives of nursing care. Expected Outcomes: conditions to be observed to show problem is prevented, controlled, resolved or eliminated. Client response/s or behavior > Specific, Measurable, Client-centered Statements/Competencies

 The plan of interventions. Decide on: Measures to help family eliminate: . barriers to performance of health tasks . underlying cause/s of non-performance of health tasks Family-centered alternatives to recognize/detect, monitor, control or manage health condition or problems Determine Methods of Nurse-Family Contact Specify Resources Needed The plan for evaluating. Criteria/Outcomes Based on Objectives of Care Methods/Tools

Family Coping Index

Physical independence: This category is concerned with the ability to move about to get out of bed, to take care of daily grooming, walking and other things which involves the daily activities. Therapeutic Competence: This category includes all the procedures or treatment prescribed for the care of ill, such as giving medication, dressings, exercise and relaxation, special diets.

 Knowledge of Health Condition: This system is concerned with the particular health condition that is the occasion of care Application of the Principles of General Hygiene: This is concerned with the family action in relation to maintaining family nutrition, securing adequate rest and relaxation for family members, carrying out accepted preventive measures, such as immunization.

 Health Attitudes: This category is concerned with the way the family feels about health care in general, including preventive services, care of illness and public health measures. Emotional Competence: This category has to do with the maturity and integrity with which the members of the family are able to meet the usual stresses and problems of life, and to plan for happy and fruitful living.

 Family Living: This category is concerned largely with the interpersonal with the interpersonal or group aspects of family life how well the members of the family get along with one another, the ways in which they take decisions affecting the family as a whole. Physical Environment: This is concerned with the home, the community and the work environment as it affects family health. Use of Community Facilities: generally keeps appointments. Follows through referrals. Tells others about Health Departments services

 Health Care Need A family health care need is present when: The family has a health problem with which they are unable to cope. There is a reasonable likelihood that nursing will make a difference in the in the familys ability to cope. Relation to Coping Nursing Need: COPING may be defined as dealing with problems associated with health care with reasonable success. When the family is unable to cope with one or another aspect of health care, it may be said to have a coping deficit

 Direction for Scaling Two parts of the Coping index: A point on the scale A justification statement The scale enables you to place the family in relation to their ability to cope with the nine areas of family nursing at the time observed and as you would expect it to be in 3 months or at the time of discharge if nursing care were provided. Coping capacity is rated from 1 (totally unable to manage this aspect of family care) to 5 (able to handle this aspect of care without help from community sources). Check no problem if the particular category is not relevant to the situation. The justification consists of brief statement or phrases that explain why you have rated the family as you have.

 General Considerations It is the coping capacity and not the underlying problem that is being rated. It is the family and not the individual that is being rated. Rating should be done after 2-3 home visits when the nurse is more acquainted with the family. The scale is as follows: 0-2 or no competence 3-5 coping in some fashion but poorly 6-8 moderately competent 9 fairly competent

 Justification- a brief statement that explains why you have rated the family as you have. These statements should be expressed in terms of behavior of observable facts. Example: Family nutrition includes basic 4 rather than good diet. Terminal rating is done at the end of the given period of time. This enables the nurse to see progress the family has made in their competence; whether the prognosis was reasonable; and whether the family needs further nursing service and where emphasis should be placed.

Community Diagnosis

What is Community Diagnosis?

As a profile, it is a description of the communitys state of health as determined by its physical, economic, political and social factors. It defines the community and states community problems As a process, it is a continuous learning experience for the nurse/program coordinator and the staff, as well as the community people.

Why undertake Community Diagnosis?

To have a clear picture of the problems of the community and to identify the resources available to the community people. Community diagnosis enables the nurse/program coordinator to set priorities for planning and developing programs of health care for the community.

What are the Types of Community Diagnosis?

The types of a community diagnosis may vary according to: The objectives or degree of detail or depth of the assessment; The resources; and The time available for the nurse to conduct the community diagnosis Comprehensive Community diagnosis aims to obtain general information about the community or a certain population Problem-oriented Community diagnosis- type of assessment that responds to a particular need

What are the elements of a Comprehensive Community Diagnosis?

Demographic Variables -should show the size, composition and geographical distribution of the population Socio-economic and Cultural Variables Social indicators Economic indicators Environmental indicators Cultural factors Other factors that may directly or indirectly affect the health status of the community

 Health and Illness Pattern -if the nurse has access to recent and reliable secondary data, then those could be used Health Resources -refer to manpower, institutional and material resources provided not only by the state but also those that are contributed by the private sector and other non-government organizations Political/ Leadership Patterns -reflect the action potential of the state and it people to address the health needs and problems of the community; mirrors the sensitivity of the government to the peoples struggle for better lives

What are the sources of data in the conduct of the community diagnosis? Primary Data - source would be the community people through survey, interview, focused group discussions, observation and through the actual minutes of community meetings Secondary data source would be organizational records of the program, health center records and other public records through review of records

What are the steps in Conducting a Community Diagnosis

Determining the Objectives nurse decides on the depth and scope of the data he/she needs to gather; regardless of the type of community diagnosis to be conducted, the nurse must determine the occurrence and distribution of selected environmental, socioeconomic and behavioral conditions important to disease prevention and wellness promotion Defining the Study Population based on the objectives, the nurse identifies the population group to be included in the study

 Preparation of the community courtesy calls for meetings are a must to enable the nurse to formulate the community diagnosis objectives with the key leaders of the community Choosing the methodology and instrument of community diagnosis

Three Levels of Data Gathering 1. Community People 2. Community health workers 3. Program staff

*INSTRUMENTS may be following: Survey questionnaire Observation checklist Interview guide

Implementation Actual data gathering Collation/ organization of data Presentation of data Analysis of data Identifying the community health nursing problems

 Health Status Problems may be described in terms of increased or decreased morbidity, mortality or fertility Health Resources Problems - they may be described in terms of lack of or absence of manpower, money, materials or institutions necessary to solve health problems Health- Related Problems they maybe described in terms of existence of social, economic, environmental and political factors aggravate the illness-inducing situations in the community

 Priority- setting of the community Health Nursing Problems Feedback to the Community community meetings are held to inform the community people of the results of the community diagnosis Action Planning action programs are the activities necessitated by the results of the community diagnosis.

 Evaluation an evaluation scheme is necessary to measure the achievements of progress of the program based on the action plan made through the Community Diagnosis.