INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

• Family structure, Characteristics, and Dynamics

o Members of the household and relationship to the head of the family

o Demographic data – age, sex, civil status, position in the family

o Place of residence of each member – whether living with the family or

elsewhere

o Type of family structure – e.g. matriarchal or patriarchal, nuclear or

extended

o Dominant family members in terms of decision-making, especially in

matters of health care

o 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 other

o Ethnic background and religious affiliation

o Significant Others – role(s) they play in family’s life

o 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 available

o Communication and transportation facilities available

• Health Status of each Family MemberMedical and nursing history indicating

o current or past significant illnesses or beliefs and practices conducive

to health illness

o 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/ practices

o Developmental assessments of infants, toddlers, and preschoolers –

e.g., Metro Manila

o 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/s

o 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 members

o Healthy lifestyle practices. Specify

o 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

 Other

o 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 Assessment

o 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 _________________________