This document outlines a typology of nursing problems in family nursing practice. It identifies several categories of nursing assessment including first-level assessment of presence of wellness conditions, health threats, health deficits, and foreseeable crisis situations. Under each category, specific problems are defined and examples are provided. Barriers to addressing these problems such as lack of knowledge, inability to make decisions, provide care, maintain a healthy home environment, and utilize community resources are also outlined.

1. A TYPOLOGY OF NURSING PROBLEMSIN
FAMILY NURSING PRACTICE
KENNEDY C. BANGAN, MSN, RN
F
ACUL
TY

2. CATEGORIES OF ASSESSMENT
FirstLevel Assessment
Second-LevelAssessment

3. First
Level
Assessment
Presenceof
Wellness Condition
Presenceof Health
Threats
Presenceof Health
Deficits
Presenceof
Foreseeable Crisis

4. PRESENCE OF
WELLNESS
CONDITION
 ST
A
TED AS POTENTIAL OR READINESS-A CLINICAL OR
NURSINGJUDGMENTABOUTACLIENTIN TRANSITION
FROMASPECIFICLEVELOF WELLNESS ORCAP
ABILITY
TOAHIGHERLEVEL.
 WELLNESSPOTENTIALIS ANURSING JUDGMENTON
WELLNESS ST
AT
E OR CONDITION BASED ON
CLIENT’S PERFORMANCE, CURRENT COMPETENCIES,
OR PERFORMANCE, CLINICAL DA
T
A OR EXPLICIT
EXPRESSIONOFDESIRETOACHIEVEAHIGHERLEVELOF
ST
A
TEOR FUNCTION IN A SPECIFIC AREAON HEAL
TH
PROMOTIONANDMAINTENANCE.

5. A. POTENTIAL FOR ENHANCED CAPABILITY FOR:
HEAL
THYLIFESTYLE
HEAL
THYMAINTENANCE/HEALTH MANAGEMENT
PARENTING
BREASTFEEDING
SPIRITUALWELL-BEING-PROCESSOFCLIENT’S
DEVELOPING/UNFOLDINGOFMYSTERYTHROUGH
HARMONIOUSINTERCONNECTEDNESSTHA
TCOMESFROM
INNERSTRENGTH/SACREDSOURCE/GOD(NANDA2001)

6. B.READINESS FOR ENHANCED CAPABILITY FOR:
HEAL
THYLIFESTYLE
HEAL
THMAINTENANCE/HEALTH MANAGEMENT
PARENTING
BREASTFEEDING
SPIRITUALWELL-BEING

7. PRESENCE OF
HEALTH THREATS
CONDITIONS THA
T ARE CONDUCIVE
TO DISEASE AND ACCIDENT
, OR MAY
RESUL
T TO F
AILURE TO MAINT
AIN
HEAL
TH
WELLNESS OR
REALIZE
POTENTIAL.

8. A. PRESENCE OF RISK FACTORS OF SPECIFIC DISEASES
B. THREATOF CROSS INFECTION FROM COMMUNICABLE
DISEASE CASE
C. FAMILY SIZE BEYOND WHATFAMILY RESOURCES CAN
ADEQUATELY PROVIDE
D. ACCIDENT HAZARDS SPECIFY.
BROKEN CHAIRS
POINTED/SHARPOBJECTS,POISONSANDMEDICINESIMPROPERL
Y
KEPT
FIREHAZARDS
F
ALLHAZARDS

9. E. FAULTY/UNHEALTHFUL NUTRITIONAL/EATING HABITS
OR FEEDING TECHNIQUES/PRACTICES.
INADEQUATEFOODINTAKEBOTHIN QUALITYAND
QUANTITY
EXCESSIVEINTAKEOFCERT
AINNUTRIENTS
F
AUL
TYEATING HABITS
INEFFECTIVEBREASTFEEDING
F
AUL
TYFEEDINGTECHNIQUES

10. F. STRESS PROVOKING FACTORS.
STRAINEDMARITALRELA
TIONSHIP
STRAINEDPARENT-SIBLINGRELA
TIONSHIP
INTERPERSONALCONFLICTSBETWEENFAMILY
MEMBERS
CARE-GIVING BURDEN

11. G. POOR HOME/ENVIRONMENTAL CONDITION/SANITATION.
INADEQUATELIVING SP
ACE
LACKOFFOODSTORAGEFACILITIES
POLLUTEDWA
TERSUPPL
Y
PRESENCEOFBREEDINGORRESTINGSIGHTSOFVECTORSOF
DISEASES
IMPROPERGARBAGE/REFUSE DISPOSAL
UNSANITARYWASTEDISPOSAL
IMPROPERDRAINAGE SYSTEM
POORLIGHTNINGANDVENTILATION
NOISE POLLUTION
AIR POLLUTION

12. H.UNHEALTHY LIFESTYLEAND PERSONAL HABITS/PRACTICES.
ALCOHOLDRINKING
CIGARETTE/TOBACCO SMOKING
WALKINGBAREFOOTEDORINADEQUATE FOOTWEAR
EATINGRAWMEA
TORFISH
POORPERSONALHYGIENE
SELFMEDICATION/SUBSTANCEABUSE
SEXUALPROMISCUITY
ENGAGINGIN DANGEROUSSPORTS
INADEQUATER
E
S
TORSLEEP
LACKOF/INADEQUATEEXERCISE/PHYSICALACTIVITY
LACKOF/RELAXATIONACTIVITIES
NON USEOFSELF-PROTECTIONMEASURES

13. I. UNSANITARY FOOD HANDLING AND PREPARATION
J. INHERENT PERSONAL CHARACTERISTICS-E.G. POOR IMPULSE
CONTROL
K. HEALTH HISTORY
, WHICH MAY PARTICIPATE/INDUCE THE
OCCURRENCE OF HEALTH DEFICIT, E.G.PREVIOUS HISTORY OF
DIFFICULT LABOR.
L. INAPPROPRIATE ROLEASSUMPTION- E.G.CHILD ASSUMING
MOTHER’S ROLE, FATHERNOT ASSUMING HIS ROLE.
M. LACK OF IMMUNIZATION/INADEQUATE IMMUNIZATION STATUS
SPECIALLY OF CHILDREN
N. FAMILY DISUNITY
SELF-ORIENTEDBEHAVIOROFMEMBER(S)
UNRESOL
VEDCONFLICTSOFMEMBER(S)
INTOLERABLEDISAGREEMENT

14. PRESENCE OF
HEALTH DEFICITS
INST
ANCES OF F
AILURE IN HEAL
TH
MAINTENANCE.

15. A. ILLNESS STATES,REGARDLESS OF WHETHER ITIS
DIAGNOSED OR UNDIAGNOSED BY MEDICAL
PRACTITIONER.
B. FAILURE TO THRIVE/DEVELOPACCORDING TO NORMAL
RATE
C. DISABILITY-WHETHER CONGENITAL OR ARISING FROM
ILLNESS;TRANSIENT/TEMPORARY OR PERMANENT

16. PRESENCE OF STRESS
POINTS/FORESEEABL
E CRISIS SITUATIONS
ANTICIP
ATED PER
IODS OF UNUSUAL
DEMAND ON THE INDIVIDUAL OR
F
AMIL
Y IN TE
RMS OF
ADJUSTMENT/FAMILYRESOURCES.

17. A. MARRIAGE
B. PREGNANCY, LABOR,
PUERPERIUM
C. PARENTHOOD
D. ADDITIONAL MEMBER
E. ABORTION
F. ENTRANCE AT SCHOOL
G. ADOLESCENCE
H. DIVORCE OR SEPARATION
I. MENOPAUSE
J. LOSS OF JOB
K. HOSPITALIZATION OFA
FAMILY MEMBER
L. DEATH OF A MEMBER
M. RESETTLEMENTIN A NEW
COMMUNITY
N. ILLEGITIMACY

18. INABILITY TO RECOGNIZE THEPRESENCE OF THECONDITION OR
PROBLEM DUE TO:
A. LACKOFORINADEQUATEKNOWLEDGE
B. DENIALABOUTITSEXISTENCEORSEVERITYASARESUL
TOFFEAROF
CONSEQUENCESOFDIAGNOSISOFPROBLEM,SPECIFICALL
Y:
SOCIAL-STIGMA,LOSSOFRESPECTOFPEER/SIGNIFICANTOTHERS
ECONOMIC/COST IMPLICATIONS
PHYSICALCONSEQUENCES
EMOTIONAL/PSYCHOLOGICAL ISSUES/CONCERNS
C. ATTITUDE/PHILOSOPHYIN LIFE,WHICHHINDERSRECOGNITION/
ACCEPT
ANCEOFAPROBLEM

19. INABILITY TO MAKE DECISIONS WITH RESPECT TO TAKING
APPROPRIATE HEALTH ACTION DUE TO:
A. F
AILURETOCOMPREHENDTHENATURE/MAGNITUDEOFTHE
PROBLEM/CONDITION
B. LOW SALIENCEOFTHEPROBLEM/CONDITION
C. FEELINGOFCONFUSION,HELPLESSNESSAND/OR RESIGNATIONBROUGHT
ABOUT BYPERCEIVE MAGNITUDE/SEVERITYOF THE SITUATIONOR
PROBLEM.
D. LACKOF/INADEQUATEKNOWLEDGE/INSIGHTASTOAL
TERNA
TIVE
COURSESOFACTIONOPENTOTHEM
E. INABILITYTODECIDEWHICHACTIONTOT
AKEFROMAMONGALISTOF
AL
TERNA
TIVES

20. F. CONFLICTINGOPINIONSAMONG FAMILYMEMBERS/SIGNIFICANTOTHERS
REGARDINGACTIONTOTAKE.
G. G. LACKOF/INADEQUATEKNOWLEDGEOFCOMMUNITYRESOURCESFOR
CARE
H. NEGATIVEA
TTITUDETOWARDSTHEHEAL
THCONDITIONORPROBLEM-BY
NEGATIVEA
TTITUDEIS MEANT ONE THA
TINTERFERESWITH RATIONAL
DECISION-MAKING
I. FEAROFCONSEQUENCESOFACTION, SPECIFICALL
Y:
SOCIALCONSEQUENCES
ECONOMIC CONSEQUENCES
PHYSICALCONSEQUENCES
EMOTIONAL/PSYCHOLOGICAL CONSEQUENCES

21. J. IN ACCESSIBILITYOFAPPROPRIATERESOURCESFORCARE,
SPECIFICALLY:
PHYSICALINACCESSIBILITY
COSTSCONSTRAINTSORECONOMIC/FINANCIAL
INACCESSIBILITY
K. LACKOFTRUST/CONFIDENCEINTHEHEAL
TH
PERSONNEL/AGENCY
L. MISCONCEPTIONSORERRONEOUSINFORMATIONABOUT
PROPOSEDCOURSE(S)OFACTION

22. INABILITY TO PROVIDE ADEQUATE NURSING CARE TO THESICK,
DISABLED, DEPENDENT OR VULNERABLE/AT RISK MEMBER OF THE
FAMILY DUE TO:
A. LACKOF/INADEQUATEKNOWLEDGEABOUTTHEDISEASE/HEALTH
CONDITION(NA
TURE,SEVERITY
,COMPLICATIONS,PROGNOSISAND
MANAGEMENT)
B. LACKOF/INADEQUATEKNOWLEDGEABOUTCHILDDEVELOPMENTAND
CARE
C. LACKOF/INADEQUATEKNOWLEDGEOFTHENA
TUREOREXTENTOF
NURSINGCARENEEDED
D. LACKOFTHENECESSARYFACILITIES,EQUIPMENTANDSUPPLIESOFCARE
E. LACKOF/INADEQUATEKNOWLEDGEORSKILLIN CARRYINGOUTTHE
NECESSARYINTERVENTIONORTREA
TMENT/PROCEDUREOFCARE

23. F. INADEQUATEFAMILYRESOURCESOFCARESPECIFICALLY:
ABSENCEOFRESPONSIBLEMEMBER
FINANCIAL CONSTRAINTS
LIMITATIONOFLUCK/LACKOFPHYSICALRESOURCES
G. SIGNIFICANTPERSONSUNEXPRESSEDFEELINGSWHICH
HIS/HERCAP
ACITIESTOPROVIDECARE.
H. PHILOSOPHYIN LIFEWHICHNEGATES/HINDERCARING
FORTHESICK,DISABLED,DEPENDENT
,VULNERABLE/ATRISK
MEMBER

24. I. MEMBER’SPREOCCUPATIONWITHON
CONCERNS/INTERESTS
J. PROLONGEDDISEASEORDISABILITIES,WHICHEXHAUST
SUPPORTIVECAPACITYOFFAMILYMEMBERS.
K. AL
TEREDROLEPERFORMANCE,SPECIFY
.
ROLEDENIALSORAMBIVALENCE
ROLESTRAIN
ROLEDISSATISFACTION
ROLECONFLICT
ROLECONFUSION
ROLEOVERLOAD

25. INABILITY TO PROVIDE A HOME ENVIRONMENT CONDUCIVE TO
HEALTH MAINTENANCE AND PERSONAL DEVELOPMENT DUE TO:
A. INADEQUATEFAMILYRESOURCESSPECIFICALL
Y:
FINANCIALCONSTRAINTS/LIMITEDFINANCIALRESOURCES
LIMITEDPHYSICALRESOURCES
B. F
AILURETOS
E
EBENEFITS(SPECIFICALL
YLONGTERMONES)OF
INVESTMENTSIN HOMEENVIRONMENTIMPROVEMENT
C. LACKOF/INADEQUATEKNOWLEDGEOFIMPORTANCEOFHYGIENEAND
SANITATION

26. D. LACKOF/INADEQUATEKNOWLEDGEOFPREVENTIVEMEASURES
E. LACKOFSKILLIN CARRYINGOUTMEASURESTOIMPROVEHOME
ENVIRONMENT
F. INEFFECTIVECOMMUNICATIONP
A
TTERNWITHINTHEFAMILY
G. LACKOFSUPPORTIVERELA
TIONSHIPAMONG FAMILYMEMBERS
H. NEGATIVEATTITUDES/PHILOSOPHYIN LIFEWHICHISNOT
CONDUCIVETOHEAL
THMAINTENANCEANDPERSONAL
DEVELOPMENT
I. LACKOF/INADEQUATECOMPETENCIESIN RELA
TINGTOEACH
OTHERFORMUTUALGROWTHANDMATURATION

27. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE
DUE TO:
A. LACKOF/INADEQUATEKNOWLEDGEOFCOMMUNITYRESOURCESFOR
HEAL
THCARE
B. F
AILURETOPERCEIVETHEBENEFITSOFHEAL
THCARE/SERVICES
C. LACKOFTRUST/CONFIDENCEINTHEAGENCY/PERSONNEL
D. PREVIOUSUNPLEASANTEXPERIENCEWITHHEAL
THWORKER
E. UNAVAILABILITYOFREQUIREDCARE/SERVICES

28. FAILURE TO UTILIZE COMMUNITY RESOURCES FOR HEALTH CARE
DUE TO:
F
. FEAROFCONSEQUENCESOFACTION(PREVENTIVE,DIAGNOSTIC,
THERAPEUTIC,REHABILIT
A
TIVE)SPECIFICALL
Y:
PHYSICAL/PSYCHOLOGICALCONSEQUENCES
FINANCIALCONSEQUENCES
SOCIALCONSEQUENCES
G. INACCESSIBILITYOFREQUIREDSERVICESDUETO:
COSTCONSTRAINS
PHYSICALINACCESSIBILITY

29. H. LACKOFORINADEQUATEFAMILYRESOURCES,SPECIFICALLY
MANPOWERRESOURCES,E.G.BABYSITTER
FINANCIALRESOURCES,COSTOFMEDICINESPRESCRIBE
I. FEELINGOFALIENATIONTO/LACKOFSUPPORTFROMTHE
COMMUNITY.
J. NEGATIVEATTITUDE/PHILOSOPHYIN LIFEWHICHHINDERS
EFFECTIVE/MAXIMUMUTILIZATIONOFCOMMUNITYRESOURCES
FORHEALTHCARE