ANGELES UNIVERSITY FOUNDATION
Angeles City
COLLEGE OF NURSING
FORMAT OF A FAMILY CASE ANALYSIS
I. INTRODUCTION
A. Objective
a. Short-term
b. Long-term
B. Entry, Climate of acceptance and first few words
II. FAMILY CONSTELLATION
Name:
Age: Present Health Status:
Position in the Family:
Gender:
Educational Status:
III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL)
a. Start from the head of the family
b. Mother’s obstetrical history (past to present)
c. Growth and Development (below seven years old
- Erik Erikson’s Psychosocial Stages
- Sigmund Freud’s Psychosexual Stages
d. Immunization Status (below 12 months)
e. Nutrition Status by age, weight and height
f. History of Past and Present Illness (if any)
g. Activities of daily living
- Sleeping pattern
- Eating pattern
- Leisure time activities
IV. SOCIO ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT
a. Type of family
b. Dominant family member(s) in terms of decision-making especially to
health care
c. Source of income, expenditures
- Adequacy to meet basic needs
- Any financial assets available in case of emergency
d. Working hours
e. Ethnic background and religious affiliation
f. Significant other’s role(s) in the family life
g. Health habits/beliefs
h. Family’s involvement in community activities
i. Family’s utilization of community resources
j. Housing condition (type of building, adequacy of living space, sleeping
arrangement, adequacy of furniture, presence of insects/rodents, accident
hazards)
k. Food sources, storage and cooking facilities
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l. Water supply (source, ownership, potability, storage)
m. Toilet facility (type, ownership, sanitary condition)
n. Drainage system (type, sanitary, condition)
o. Social and health facilities available
p. Communication and transportation facilities
V. PROBLEM IDENTIFICATION
A. List of Problem Identified (prioritized)
B. Priority Setting
PROBLEM #
CRITERIA COMPUTATION SCORE JUSTIFICATION
Nature of the Problem
- Wellness State
- Health Deficit
-Health Threat
-Foreseeable Crisis
Modifiability
- Easily modifiable
- Partially Modifiable
- Not Modifiable
Preventive Potential
- High
- Moderate
- Low
Salience
-A condition or a problem,
needing immediate
attention
-A condition or a problem
not needing immediate
attention
-Not perceived as a
problem or condition
needing change
VI. FAMILY NURSING CARE PLAN (in order of priority)
PROBLEM #
TITLE:
Cues Analysis Objectives Nursing Rationale Method Resources Expected
of the Intervention of Required Outcomes
Problem Family
Contact
Health Conditions Nursing Problems Supporting Data Date Identified Date resolved
and Problems Cues
Family Nsg. Cues Goal & Intervention Plans Evaluation
Problem Objectives
Inability to Nursing Method & Standards Methods &
Intervention Resources Tools
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VII. FAMILY COPING INDEX
CATEGORY INITIAL FINAL JUSTIFICATION
1 3 5 1 3 5
VIII. LEARNING DERIVED
IX. SOCIOGRAM and DOCUMENTATION (With day-to-day objectives and detailed
account of what has transpired during the day, e.g. implementations, accomplishments
for the day, etc; you may Include pictures of before and after for the FCA if applicable)
X. FLOOR PLAN, SPOT MAP
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June 4, 2010-Rev.1
