Family and Community Assessment

8/3/2019 Family and Community Assessment

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FAMILY ANDCOMMUNITY

ASSESSMENT


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Family Nursing Process


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involves a set of actions by which the

nurse measures the status of the familyas a client, its ability to maintain itselfas a system and functioning unit, its

ability to maintain wellness, prevent,control or resolve problems in order toachieve health and well-being amongits members.


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a.) family structure, characteristics &

dynamics include the composition anddemographic data of the members of thefamily/household, their relationship to the

head and place of residence; the type of,and family interaction/communication anddecision-making patterns and dynamics.

Initial Data base


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b.) socio-economic & cultural

characteristics include occupation,place of work, and income of eachworking member; educational attainment

of each family member; ethnicbackground and religious affiliation;significant others and the other role(s)they play in the familys life; and, the

relationship of the family to the largercommunity.


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c.) home and environment include

information on housing and sanitationfacilities; kind of neighborhood andavailability of social, health,

communication and transportationfacilities in the community.


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d.)health status of each member

includes current and past significantillness; beliefs and practices conducive tohealth and illness; nutritional and

developmental status; physicalassessment findings and significantresults of laboratory/diagnostictests/screening procedures.


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e.) values and practices on health

promotion/maintenance & diseaseprevention include use of preventiveservices; adequacy of rest/sleep,

exercise, relaxation activities, stressmanagement or other healthy lifestyleactivities, and immunization status of at-risk family members.


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I. PRESENCE OF WELLNESS CONDITION stated as

Potential or Readiness- a clinical or nursing judgment about aclient in transition from a specific level of wellness or capabilityto a higher one

II. PRESENCE OF HEALTH THREATS conditions that are

conducive to disease and accident, or may result to failureto maintain wellness or realize health potential.

III. PRESENCE OF HEALTH DEFICITS instances of failurein health maintenance.

IV. PRESENCE OF STRESS POINTS/FORESEEABLE CRISISSITUATIONS anticipated periods of unusual demand onthe individual or family in terms of adjustment/familyresources.

FIRST- LEVEL ASSESSMENT


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I. Inability to recognize the presence of the condition

or problem.

II. Inability to make decisions with respect to takingappropriate health action.

III. Inability to provide adequate nursing care to thesick, disabled, dependent or vulnerable/at-riskmember of the family.

IV. Inability to provide a home environment conduciveto health maintenance and personal development.

V. Failure to utilize community resources for healthcare.

SECOND-LEVEL ASSESSMENT


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Nature of the Problem

Wellness condition

Health deficits

Health threats Foreseeable crisis

Preventive Potential refers to the

nature and magnitude of future problemsthat can be minimized or totally preventedif intervention is done on the problemunder consideration

Problem Prioritization


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Modifiability of the Condition refers to theprobability of success in enhancing the wellnessstate, improving the condition, minimizing,alleviating or totally eradicating the problemthrough intervention

Saliencerefers to the familys perception andevaluation of the problems in terms of seriousnessand urgency of attention needed


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Criteria

Score

Weight

Nature of the ConditionWellness State 3

1Health Deficit 3Health Threat 2Foreseeable Crisis 1Modifiability of the ConditionEasily Modifiable 2

1Partially Modifiable 1Not Modifiable 0Preventive PotentialHigh 2

1Moderate 2Low 1SalienceA condition needing immediate attention 2

1A condition not needing immediate attention 1Not perceived as a condition needing change 0

Scale for Ranking Health Conditions andProblems according to Priorities


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THE FAMILY CARE PLAN is the blueprint of the

care that the nurse designs to systematically

minimize or eliminate the identified health andfamily nursing problems through explicitlyformulated outcomes of care ( goals and

objectives) and deliberately chosen of

interventions, resources and evaluation criteria,standards, methods and tools.

DEVELOPING THE NURSINGCARE PLAN


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It should be based on clear, explicit definition ofthe problems. A good nursing plan is based on acomprehensive analysis of the problem situation.

A good plan is realistic.

The nursing care plan is prepared jointly with thefamily. The nurse involves the family indetermining health needs and problems, inestablishing priorities, in selecting appropriatecourses of action, implementing them andevaluating outcomes.

The nursing care plan is most useful in writtenform.

DESIRABLE QUALITIES OF A NURSING CARE PLAN


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They individualize care to clients. The nursing care plan helps in setting priorities by

providing information about the client as well as thenature of his problems.

The nursing care plan promotes systematic

communication among those involved in the healthcare effort.

Continuity of care is facilitated through the use ofnursing care plans. Gaps and duplications in theservices provided are minimized, if not totallyeliminated.

Nursing care plans, facilitate the coordination of careby making known to other members of the healthteam what the nurse is doing.

THE IMPORTANCE OF PLANNING CARE


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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 isprevented, controlled, resolved or eliminated.

Client response/s or behavior

> Specific, Measurable, Client-centeredStatements/Competencies

STEPS IN DEVELOPING A FAMILY NURSINGCARE PLAN


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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 orproblems

Determine Methods of Nurse-Family Contact

Specify Resources Needed

The plan for evaluating.

Criteria/Outcomes Based on Objectives of Care

Methods/Tools


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Family Coping Index

Physical independence: This category isconcerned with the ability to move about to getout of bed, to take care of daily grooming, walkingand other things which involves the daily

activities.

Therapeutic Competence: This categoryincludes all the procedures or treatmentprescribed for the care of ill, such as giving

medication, dressings, exercise and relaxation,special diets.


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Knowledge of Health Condition: Thissystem is concerned with the particular healthcondition that is the occasion of care

Application of the Principles of GeneralHygiene: This is concerned with the familyaction in relation to maintaining familynutrition, securing adequate rest andrelaxation for family members, carrying out

accepted preventive measures, such asimmunization.


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Health Attitudes: This category isconcerned with the way the family feelsabout health care in general, includingpreventive services, care of illness and

public health measures.

Emotional Competence: This categoryhas to do with the maturity and integritywith which the members of the family are

able to meet the usual stresses andproblems of life, and to plan for happy andfruitful living.


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Family Living: This category is concernedlargely with the interpersonal with the

interpersonal or group aspects of familylife how well the members of the familyget along with one another, the ways inwhich they take decisions affecting thefamily as a whole.

Physical Environment: This is concernedwith the home, the community and thework environment as it affects familyhealth.

Use of Community Facilities: generallykeeps appointments. Follows throughreferrals. Tells others about HealthDepartments services


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Health Care NeedA 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 thefamilys ability to cope.

Relation to Coping Nursing Need:

COPING may be defined as dealing with

problems associated with health care withreasonable success.

When the family is unable to cope with oneor another aspect of health care, it may besaid to have a coping deficit


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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 theirability to cope with the nine areas of family nursing at the

time observed and as you would expect it to be in 3 monthsor at the time of discharge if nursing care were provided.Coping capacity is rated from 1 (totally unable to managethis aspect of family care) to 5 (able to handle this aspect ofcare 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 thatexplain why you have rated the family as you have.


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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 thefamily.

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


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Justification- a brief statement thatexplains why you have rated the family as

you have. These statements should beexpressed in terms of behavior ofobservable facts. Example: Family

nutrition includes basic 4 rather than gooddiet.

Terminal rating is done at the end of thegiven period of time. This enables thenurse to see progress the family has made

in their competence; whether theprognosis was reasonable; and whetherthe family needs further nursing serviceand where emphasis should be placed.


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Community Diagnosis


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As a profile, it is a description of thecommunitys state of health as determined by its

physical, economic, political and social factors. Itdefines the community and states community

problems As a process, it is a continuous learning

experience for the nurse/program coordinatorand the staff, as well as the community people.

What is Community Diagnosis?


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To have a clear picture of the problems of thecommunity and to identify the resources available tothe community people.

Community diagnosis enables the nurse/program

coordinator to set priorities for planning anddeveloping programs of health care for thecommunity.

Why undertake Community Diagnosis?


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The types of a community diagnosis may vary accordingto:

The objectives or degree of detail or depth of theassessment;

The resources; and The time available for the nurse to conduct thecommunity diagnosis

Comprehensive Community diagnosis aims to obtaingeneral information about the community or a certain

population Problem-oriented Community diagnosis- type of

assessment that responds to a particular need

What are the Types ofCommunity Diagnosis?


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Demographic Variables

-should show the size, composition and geographicaldistribution 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

What are the elements of aComprehensive Community Diagnosis?


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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 providednot only by the state but also those that are contributed by theprivate sector and other non-government organizations

Political/ Leadership Patterns

-reflect the action potential of the state and it people to addressthe health needs and problems of the community; mirrors thesensitivity of the government to the peoples struggle for betterlives


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Primary Data - source would be the communitypeople through survey, interview, focused groupdiscussions, observation and through the actualminutes of community meetings

Secondary data source would be organizationalrecords of the program, health center records andother public records through review of records

What are the sources of data in the conduct of thecommunity diagnosis?

What are the steps in Conducting a


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Determining the Objectives nurse decideson the depth and scope of the data he/sheneeds to gather; regardless of the type ofcommunity diagnosis to be conducted, the

nurse must determine the occurrence anddistribution of selected environmental, socio-economic and behavioral conditions importantto disease prevention and wellness promotion

Defining the Study Population based onthe objectives, the nurse identifies thepopulation group to be included in the study

What are the steps in Conducting aCommunity Diagnosis


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Preparation of the communitycourtesy calls for meetings are a must toenable the nurse to formulate thecommunity diagnosis objectives with the

key leaders of the community

Choosing the methodology andinstrument of community diagnosis


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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


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Implementation

Actual data gathering

Collation/ organization of data

Presentation of data Analysis of data

Identifying the community healthnursing problems


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Health Status Problems may be described in termsof increased or decreased morbidity, mortality orfertility

Health Resources Problems - they may bedescribed in terms of lack of or absence of manpower,money, materials or institutions necessary to solvehealth problems

Health- Related Problems they maybe described interms of existence of social, economic, environmentaland political factors aggravate the illness-inducingsituations in the community


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Priority- setting of the community Health

Nursing Problems

Feedback to the Community communitymeetings are held to inform the community people

of the results of the community diagnosis

Action Planning action programs are theactivities necessitated by the results of thecommunity diagnosis.


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Evaluation an evaluation scheme isnecessary to measure the achievementsof progress of the program based on theaction plan made through the Community

Diagnosis.


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Family and Community Assessment

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