ANGELES UNIVERSITY FOUNDATION

Angeles City

COLLEGE OF NURSING

FORMAT OF A FAMILY CASE ANALYSIS

I. INTRODUCTION
A. Objectives
a. Student-Centered
i. Short-term (first two homevisit)
ii. Long-term (duration of home visit
b. Family-Centered
i. Short-term
ii. Long-term

II. FAMILY CONSTELLATION

Gende
Name Age Position in the Family Educational Status Present Health Status
r

III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL) – INITIAL ASSESSMENT

a. Start from the head of the family
b. Mother’s obstetrical history (past to present)
c. Growth and Development (below six years old)
- Erik Erikson’s Psychosocial Stages
- Sigmund Freud’s Psychosexual Stages
d. Immunization Status (below 12 months – if any)
e. Nutrition Status by age, weight and height - BMI
f. History of Past and Present Illness (if any) / chronologically arranged up to
present
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
l. Water supply (source, ownership, storage)
m. Toilet facility (type, 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 Problems Identified (prioritized)

B. Priority Setting

PROBLEM #

COMPUTATIO SCOR
CRITERIA JUSTIFICATION
N E
Nature of the Problem
- Wellness State
- Health Deficit
- Health Threat
- Foreseeable Crisis

Modifiability of the Problem

- Easily modifiable
- Partially Modifiable
- Not Modifiable

Current knowledge, technology and intervention

Family Resources
Resources of the Nurse
Community Resources

Preventive Potential
- High
- Moderate
- Low

Gravity/severity of the
problem
Duration of the problem
Current management
Exposure of high risk groups

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

TOTAL SCORE:
VI. FAMILY NURSING CARE PLAN (in order of priority)

PROBLEM #
TITLE:

NURSING SUPPORTING DATE GOALS AND Intervention plans Evaluation

PROBLEMS DATA CUES IDENTIFIED: OBJECTIVES
(2ND Level DATE
Assessment) RESOLVED:

Nursing Method Standards Methods

Interventions and and Tools
Resource
s

VII. LEARNING DERIVED

VIII. 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)

IX. FLOOR PLAN, SPOT MAP