Professional Documents
Culture Documents
COLLEGE OF NURSING
RELATIONSHIP TO HIGHEST
NAME GENDER AGE HEAD OF EDUCATIONAL OCCUPATION HEALTH PROBLEMS
HOUSEHOLD ATTAINMENT
11 | P a g e
GENOGRAM OF ___________________ FAMILY
(NAME)
Child Child
5. Infectious diseases
TB
Hepatitis
Chicken Pox
Measles
Others : _______________________
B. FAMILY CHARACTERISTICS
3. Family dynamics
3.1 Emotional bonding of family members _____________________________
3.2 Distribution of authority and power _______________________________
3.3 How members communicate _______________________________
3.4 How problems are solved _______________________________
3.5 How conflict is handled _______________________________
3.6 Division of labor _______________________________
E. FAMILY ENVIRONMENT
1. Home
2. Water Supply
3. Kitchen
3.1. Cooking Facility ( ) electric stove ( ) gas stove
( ) firewood / charcoal
3.2. Sanitary Condition __________________________________________
4. Water Disposal
4.1. Refuse and Garbage
4.1.1. Container ( ) covered ( ) open
( ) none
F. FAMILY NEIGHBORHOOD
1. Location ______________________________________________
(urban, rural, subdivision, slum area)
2. Type ______________________________________________
(residential, semi commercial, commercial)
3. Safety
3.1. Traffic pattern _______________________
3.2. Lighting _______________________
3.3. Security _______________________
4. Population density _______________________
(crowding)
5. Sources of pollution
5.1. Air _______________________
5.2. Water _______________________
5.3. Soil _______________________
5.4. Noise _______________________
________________________________________________
(how family spends a typical day)
2. Health Problems
2.1. Health Deficit / Need: (condition that can be alleviated with medical or social
technology)
____________________________
____________________________
____________________________
2.2. Health Threats (conditions that will promote or cause disease(s) or injury(ies))
____________________________
____________________________
____________________________
2.3. Foreseeable crisis (stressful conditions)
____________________________
____________________________
____________________________
3. Home Remedies
____________________________
____________________________
____________________________