Family Nursing Care Plan: Assessment & Diagnoses in Family Nursing Practice

The family nursing process is the standard nursing process applied to the family, the unit of care in the community. Use these common assessment cues and diagnoses when you build a Family Nursing Care Plan.

First-Level Assessment

First-level assessment determines the family's existing and potential health conditions or problems. Categorize them as follows.

I. Presence of a Wellness Condition

Stated as "potential" or "readiness." A clinical or nursing judgment that a client is moving from one level of wellness or capability to a higher one, based on the client's performance, current competencies, clinical data, or explicit desire to reach a higher level of health promotion and maintenance. Examples:

A. Potential for enhanced capability for:

• Healthy lifestyle, e.g. nutrition/diet, exercise/activity
• Health maintenance/health management
• Parenting
• Breastfeeding
• Spiritual well-being (developing the client's connection to inner strength, a sacred source, or God)
• Others. Specify.

B. Readiness for enhanced capability for:

• Healthy lifestyle
• Health maintenance/health management
• Parenting
• Breastfeeding
• Spiritual well-being
• Others. Specify.

II. Presence of Health Threats

Conditions conducive to disease or accident, or that may lead to failure to maintain wellness or realize health potential. Examples:

A. Risk factors for specific diseases (e.g. lifestyle diseases, metabolic syndrome, smoking).

B. Threat of cross infection from a communicable disease case.

C. Family size beyond what family resources can adequately provide.

D. Accident hazards. Specify.

• Broken chairs
• Pointed/sharp objects, poisons, and medicines improperly kept
• Fire hazards
• Fall hazards
• Others. Specify.

E. Faulty or unhealthful nutritional/eating habits or feeding techniques. Specify.

• Inadequate food intake in quality and quantity
• Excessive intake of certain nutrients
• Faulty eating habits
• Ineffective breastfeeding
• Faulty feeding techniques

F. Stress-provoking factors. Specify.

• Strained marital relationship
• Strained parent-sibling relationship
• Interpersonal conflicts between family members
• Caregiving burden

G. Poor home/environmental condition or sanitation. Specify.

• Inadequate living space
• Lack of food storage facilities
• Polluted water supply
• Breeding or resting sites of disease vectors
• Improper garbage/refuse disposal
• Unsanitary waste disposal
• Improper drainage system
• Poor lighting and ventilation
• Noise pollution
• Air pollution

H. Unsanitary food handling and preparation.

I. Unhealthy lifestyle and personal habits. Specify.

• Alcohol drinking
• Cigarette/tobacco smoking
• Walking barefoot or in inadequate footwear
• Eating raw meat or fish
• Poor personal hygiene
• Self-medication/substance abuse
• Sexual promiscuity
• Engaging in dangerous sports
• Inadequate rest or sleep
• Lack of or inadequate exercise/physical activity
• Lack of relaxation activities
• Non-use of self-protection measures (e.g. not using bed nets in malaria- and filariasis-endemic areas)

J. Inherent personal characteristics (e.g. poor impulse control).

K. Health history that may precipitate a health deficit (e.g. previous history of difficult labor).

L. Inappropriate role assumption (e.g. a child assuming the mother's role, a father not assuming his role).

M. Lack of or inadequate immunization status, especially of children.

N. Family disunity.

• Self-oriented behavior of member(s)
• Unresolved conflicts of member(s)
• Intolerable disagreement

O. Others. Specify.

III. Presence of Health Deficits

Instances of failure in health maintenance. Examples:

A. Illness states, whether diagnosed or undiagnosed by a medical practitioner.

B. Failure to thrive or develop according to normal rate.

C. Disability, congenital or arising from illness, either transient (e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg amputation, blindness from measles, lameness from polio).

IV. Presence of Stress Points or Foreseeable Crisis Situations

Anticipated periods of unusual demand on the individual or family in terms of adjustment or family resources. Examples:

• Marriage
• Pregnancy, labor, puerperium
• Parenthood
• Additional member (e.g. newborn, lodger)
• Abortion
• Entrance at school
• Adolescence
• Divorce or separation
• Menopause
• Loss of job
• Hospitalization of a family member
• Death of a member
• Resettlement in a new community
• Illegitimacy
• Others. Specify.

Second-Level Assessment

Second-level assessment identifies the nature or type of nursing problems a family faces in performing its health tasks for a given health condition.

I. Inability to recognize the presence of the condition or problem, due to:

A. Lack of or inadequate knowledge.

B. Denial of its existence or severity from fear of the consequences of diagnosis, specifically:

• Social stigma, loss of respect of peers or significant others
• Economic/cost implications
• Physical consequences
• Emotional/psychological concerns

C. An attitude or philosophy of life that hinders recognition or acceptance of a problem.

D. Others. Specify.

II. Inability to make decisions about appropriate health action, due to:

A. Failure to comprehend the nature or magnitude of the problem.

B. Low salience of the problem.

C. Confusion, helplessness, or resignation from the perceived magnitude of the problem, i.e. failure to break the problem into manageable units of attack.

D. Lack of or inadequate knowledge of the alternative courses of action open to them.

E. Inability to decide which action to take among the alternatives.

F. Conflicting opinions among family members or significant others about the action to take.

G. Lack of or inadequate knowledge of community resources for care.

H. Fear of the consequences of action, specifically:

• Social consequences
• Economic consequences
• Physical consequences
• Emotional/psychological consequences

I. A negative attitude toward the health condition that interferes with rational decision-making.

J. Inaccessibility of appropriate resources for care, specifically:

• Physical inaccessibility
• Cost constraints or economic/financial inaccessibility

K. Lack of trust or confidence in the health personnel or agency.

L. Misconceptions or erroneous information about the proposed course(s) of action.

M. Others. Specify.

III. Inability to provide adequate nursing care to a sick, disabled, dependent, or at-risk member, due to:

A. Lack of or inadequate knowledge about the disease or health condition (nature, severity, complications, prognosis, management).

B. Lack of or inadequate knowledge about child development and care.

C. Lack of or inadequate knowledge of the nature or extent of nursing care needed.

D. Lack of the necessary facilities, equipment, and supplies for care.

E. Lack of or inadequate knowledge or skill in carrying out the necessary intervention or treatment (i.e. a complex therapeutic regimen or healthy lifestyle program).

F. Inadequate family resources for care, specifically:

• Absence of a responsible member
• Financial constraints
• Lack of physical resources

G. Significant persons' unexpressed feelings (e.g. hostility/anger, guilt, fear/anxiety, despair, rejection) that limit their capacity to provide care.

H. A philosophy of life that hinders caring for the sick, disabled, dependent, or at-risk member.

I. A member's preoccupation with their own concerns or interests.

J. Prolonged disease or disability that exhausts the supportive capacity of family members.

K. Altered role performance. Specify.

• Role denial or ambivalence
• Role strain
• Role dissatisfaction
• Role conflict
• Role confusion
• Role overload

L. Others. Specify.

IV. Inability to provide a home environment conducive to health maintenance and personal development, due to:

A. Inadequate family resources, specifically:

• Financial constraints or limited financial resources
• Limited physical resources, e.g. lack of space to build a facility

B. Failure to see the benefits, especially longterm ones, of investing in home environment improvement.

C. Lack of or inadequate knowledge of the importance of hygiene and sanitation.

D. Lack of or inadequate knowledge of preventive measures.

E. Lack of skill in carrying out measures to improve the home environment.

F. Ineffective communication patterns within the family.

G. Lack of supportive relationships among family members.

H. A negative attitude or philosophy of life not conducive to health maintenance and personal development.

I. Lack of adequate 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 because the family is preoccupied with the current problem.

J. Others. Specify.

V. Failure to use community resources for health care, due to:

A. Lack of or inadequate knowledge of community resources for health care.

B. Failure to perceive the benefits of health care or services.

C. Lack of trust or confidence in the agency or personnel.

D. Previous unpleasant experience with a health worker.

E. Fear of the consequences of action (preventive, diagnostic, therapeutic, rehabilitative), specifically:

• Physical/psychological consequences
• Financial consequences
• Social consequences

F. Unavailability of the required care or services.

G. Inaccessibility of required services, due to:

• Cost constraints
• Physical inaccessibility

H. Lack of or inadequate family resources, specifically:

• Manpower resources, e.g. babysitter
• Financial resources, e.g. cost of medicines prescribed

I. Feeling of alienation from or lack of support from the community (e.g. stigma from mental illness, AIDS).

J. A negative attitude or philosophy of life that hinders effective use of community resources for health care.

K. Others. Specify.