Family Care Plan

A paper presented to the Faculty of the

College of Nursing of the Adventist
University of the Philippines

In Partial Fulfillment of the Requirements for the

Course Community Health Nursing

By:

Name of student
Date submitted
 Adventist University of the Philippines
COLLEGE OF NURSING

FAMILY ASSESSMENT GUIDE

FIRST LEVEL ASSESSMENT

Date Assessed: June 26-27,2019

I. Family Structure, Characteristics, and Dynamics

Family Name Salvacion Address Purok 10, Mangga st., Brgy. Bignay, Cavite

A. Demographic Data
Household Number Block 12 lot 4 Barangay House NA
No.

Family Data
Length of residency 1 year
Place of origin: Bohol
Family size: 6
Religion: Husband Roman Catholic
Wife Roman Catholic

Family Member’s Chart

Relationship to Family
Family Members Age Sex Civil Status Position in the Family
Head
1. Dino 45 M Married Father Head of the family
2. Rina 49 F Married Mother Wife
3. Eugene 22 M Single 3rd Son Son
4. Wally 20 M Single 4th Son Son
5. Rome 18 M Single 5th Son Son
6. Grace 16 F Single 6th daughter / Youngest Daughter

B. Family Characteristics
Type of Family Structures
Family Description Please check applicable
Nuclear Dyad, Cohabitation, Single-parent, Blended, Communal, Foster, Adoptive,
Single living alone, Elder living alone
Extended Single with relatives, Elder with relatives, nuclear with non-immediate family
dependents
Others Gay/Lesbian
C. General Family Relationship/Dynamic

SMILKSTEIN'S FAMILY SYSTEM APGAR ITEMS (Smilkstein, 1976)

Component Items Score Justification

Adaptation Can you turn to your family for help if
something is troubling you?
Partnership Are you satisfied with the way your family talk
things over with you and shares problems with
you?
Growth Are you satisfied that your family accepts and
supports your wishes to take on new activities
or directions?
Affection Are you satisfied with the way your family
expresses affection and
responds to your emotions, such as anger,
sorrow, and love?
Resolve Are you satisfied with the way your family and
you share time together?
TOTAL
Scoring: 0 point = “Hardly ever” Interpretation: 0-3 = severely dysfunctional family
1 point = “Some of the time”
2 points = “Almost always”
2 Both parents help each other in terms of
financial and health problems.
2 They have a good relationship when it comes
to decision making such as
financial concerns. The couple discussed it
together with their children. In terms in
decision making to health, the father is the
one who decides and plan for a good health.
2 The mother stated that there were no vices
practiced in the family. But her husband
drinks occasionally. They can eat times a day
together with snack.
2 The family always has time to bond with each
other by doing recreational activities
such watching movies and videoke.
2 The family has no enough time especially in
problems with their children.
10 The family Apgar result is 10 which means
that their family is highly functional. It shows
that their family is
able to communicate well and use the
appropriate resource available in the
community.
4-6 = Moderately dysfunctional Family
7-10 = Highly functional Family

Family Function and Roles

Father Mother
Roles Description
(please check to whom applicable)
Wage Earner The one who supplies the bulk of the income for the family
Financial Manager Supervises the family finances (pays the bills, provides for
future savings)
Problem-solver The family depend on to provide the solution for problems

Decision-maker Makes decisions, particularly in the area of lifestyle and

leisure time
Gate Keeper Determines what information will be release from the family
or what new information can be introduced.

Patriarchal/Matriarchal? (Please refer to Family functions & roles) Patriarchal

Significant other/s aside from parents, who makes decision for the family?
None____________________________________________________________________________

II. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

 Position in the Educational
Family Members Ethnicity Religion Occupation
Family Attainment

1. Dino Head Tagalog Roman 3rd Year High Butcher / Truck

Catholic School Driver
2. Rina Wife Tagalog Roman 3rd Year High Housewife
Catholic School
3. Eugene 3rd Son Tagalog Roman 1st Year Assistant Butcher
Catholic College (works with
Father)
4. Wally 4th Son Tagalog Roman Grade 10 None
Catholic
5. Rome 5th Son Tagalog Roman Grade 12 Student
Catholic (Currently)
6. Grace 6th/ Youngest Tagalog Roman Grade 5 None
Daughter Catholic

Who makes decisions about money and how it is spent? Rina Salvacion

Monthly Family Income Source

Husband 3,000 Pesos weekly
Wife No Income
Others Eugene-3,000 Pesos weekly (when working)

Monthly Family Income

TOTAL (checked bracket)
Php 5,000 Php 20,000 - 30,000
Php 5,000 – 10,000 Php 30,000 – 40,000
Php 10,000 – 15,000 Php 40,000 – 50,000
Php 15,000 – 20,000 Php 50,000 & above
 Significant Others Roles they play to the family life
NA NA

Relationship of the family to larger community (describe the nature and extent of participation of the family in the
community activities)
____________________________________NA___________________________________________________________
______________________________________________________________________________

III. HOME AND ENVIRONMENT

1. Home
a. Ownership: Owned __Rented Rent-free Others (Specify)

b. Construction materials used: Wood Concrete Mixed

Makeshift Others, specify

c. Number of rooms used for sleeping 2 (separated only by a makeshift wall made of cloth
and blankets)

d. Lighting facilities Electricity Kerosene Others, specify

e. What are the appliances owned by the family? Television and Radio
_________________________________________________________________________________________________

f. General sanitary condition: Poor as the family is living in a congested area

2. Water Supply
a. Drinking water
Source: Deep well Shallow well Springs Others, specify

Distance from house: Faucet for water is inside the house

Storage: Jars Bottles Plastic pitcher Others, specify

3. Kitchen
a. Cooking facility Electric stove Gas stove Firewood/Charcoal

b. Food storage Refrigerator Cabinet Pots/pans, etc.

c. Sanitary condition:

d. Drainage facility None Open Closed

4. Waste Disposal
a. Refuse and Garbage
1. Container: ______ plastic bag ______ sacks ______ Others, specify ___________________

2. Method of Disposal: ______ none ______ dumping ______ burning ______ burying
______ waste segregation ______ feeding to animals
______ throw in river/sewer ______ Others, specify __________________

b. Toilet
1. Type
______ Pit privy ______ Water-sealed (Septic) ____water sealed (Sewer) _____others(specify)

2. Distance from house Toilet is inside the house as a separate room

3. Identify if there is sharing of toilets with other families The toilet is exclusively used by Salvacion Family

c. Type of drainage system

Open____________ With Cover________________

5. Domestic Animals
Kind Number Where Kept Vaccination Status
Dog 1 Inside the house Rabies- 1/21/2021
Chicken 2 Chicken coop/Backyard NA

6. Identify presence of breeding sites for vector diseases.

Drums of water, Dog, dirty corners of the house, etc.
7. Identify potential accident hazards
House is a mix of concrete and wood fire could easily spread among houses, poor drainage system of the
area could lead to flash flood, and unstable foundations could lead to collapse during earthquakes.
8. Describe the neighborhood (i.e. slums, congested & etc.)\
Congested houses of poor quality and build, very similar to a slum like area but livable. Not ideal but
livable.
9. Recreational Facilities
None
10. Availability of Health Care Facilities and Health Manpower Resources
An ambulance is stationed near the garbage disposal area (the only area wide enough to park an
ambulance) and the health care center is approximately 1km from the area
11. Distance of House from nearest Health Care Facility
Approximately 1km from the house
12. a. Communication facilities
o Cellphone
o Landline
o Letter
o Internet
o Others (specify)______
 b. Transportation facilities
o Private car
o Motorcycle
o Tricycle
o Jeep
o Bike
o Others (specify)______

IV. FAMILY HEALTH STATUS

A. Common Illnesses encountered for the last 6 months and the treatment applied/given.
Illness Treatment
Grace – Typhoid Fever (Last February 2021) Admitted to the hospital for 5 days
Dino – Knee pain from overexertion Flanax cream

B. Nutritional Assessment
Family Dietary Habits
What did you eat yesterday? (24-hour Dietary recall)
Breakfast Rice, Fried Egg, Coffee, Water
Lunch Rice, Fried Chicken, Water
Supper Rice, Chicken Adobo, Water

Family Member Body mass Index Classification

1. Dino 25.68 / DBW = 58.59kg Overweight
2. Rina 26.24 / DBW = 49.45kg Overweight
3. Eugene 19.16 / DBW = 49.45kg Normal
4. Wally 20.76 / DBW = 60.92kg Normal
5. Rome 17.96 / DBW = 54.02kg Underweight
6. Grace 17.91 / DBW = 49.45kg Underweight

C. Developmental Assessment of Infants, toddlers, and preschoolers

Family Member MMDST result

NA NA

D. Identification of risk factors for specific lifestyle disease through the use of Gordon’s health assessment tool.

E. Physical Assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioner)

F. Results of laboratory/diagnostic and other screening procedures.

V. FAMILY VALUES, AND HEALTH PRACTICES

A. Immunization status of family members (For Children ages 0-5 years old)
Family member Immunization Status
NA

B. Identify healthy lifestyle practices

Free from vices such as smoking and drugs.
C. Adequacy of rest and sleep, exercise, use of protective measure (bet nets, footwear), relaxation and other
stress management activities (you can also use the Gordon’s assessment tool here)

D. Use of promotive-preventive health services

E. Whom do you consult for health related problems?

Manghihilot Albularyo

Midwife Nurse
Doctor Health Center
BHW Others, specify _________________

F. For problems other than health, whom do you consult?

Family members Relatives

Friends Barangay Officials

Priest/pastor Others, specify _________________
Identified Problems from the Initial Data Base (1st Level Assessment)

Problem Cues

Poor Home Objective:

Sanitation: Polluted • Grace acquired
Water typhoid fever just
recently
• The family does not
filter out water
• The drainage from
the family’s toilet
leads to the same
area that the pipes
for tap water pass

Objective:
• Family’s 24hr food
recall mainly
consisted of meat
• 2 members of the
Malnutrition family are
overweight while 2
members of the
family are
underweight or
malnourished
 Narrative Form of Initial Family Assessment

I. Family Structure, Characteristics, and Dynamics

The Salvacion family is a family of 8, but only 6 out of 8 live in Purok10, Brgy. Manga . During the first
interview, only the Mother, Mrs. Salvacion, was available to answer the questions. They have lived in the house
for a year as they have just moved from another area of the same barangay. The family consists of Dino
Salvacion who is the breadwinner and worker of the family, Rina Salvacion who is the home maker and
caretaker of the house, and their children, Eugene, Wally, Rome, and Grace, the names of the 2 eldest sons were
not mentioned. They live in a nuclear type family structure and only 4 out of the 6 children live with the 2 eldest
sons have married and moved to Sta. Rosa and were not available for interview. There were no observable
conflicts throughout the 1st and 2nd level assessment of the family. Family is clear with what they want and
when they want it to each member of the family. Family bond is strong with observable family members, and
the children respect their parents.

The Father, Mr. Salvacion the main wage earner of the family, but Eugene occasionally accompanies Mr.
Salvacion to work to earn additional wage for the family. Mrs. Salvacion is the Financial Manager delegating
the funds to their respective needs. Both the parents take part in solving the problems in the family making sure
that the problem is solved decisively and quickly based on the situation. The main decision maker is Mr.
Salvacion who is the head of the family while Mrs. Salvacion is the gate keeper, ensuring that no important
information is spread out from the family, and harmful information comes in. The family is Patriarchal in nature
and no other significant persons other than the parents make major decisions for the family.

II. Socio-economic and Cultural Characteristics

The family is Tagalog in ethnicity and are all Roman Catholic. The parents are both 3rd year high school
graduates, Eugene graduated 4th year high school but did not continue to college, Wally graduated grade 10 but
is hesitant about continuing to college or senior high school, Rome is currently grade 12 and a student, while
Grace had to stop school and has not gone back after 5th grade. Mr. Salvacion and Eugene are the main sources
of income for the family and they work as butchers in the market in Sta. Rosa earning a max approximate
18,000 per month, but usually only 12,000 pesos per month. The family does not actively participate in
community activities.

III. Home and Environment

IV. Family Health Status

V. Family Values and Health Practices

 Family Health Problem
2nd Level Assessment
Name of Student Section: A

I. Imbalanced Nutritional Intake

1. Inability to make decisions with respect to taking appropriate health action due to low salience of the
health problem.
“Ok naman ang diet namin, kumakain naman kami ng gulay, pero open naman kami po sa mga
suggestions”

Mrs. Salvacion and company states that they eat more meat than veggies, and that they do not see the need to
change their diet as it will hinder her husband’s work. And the children still prefer meat over vegetables. They
do not have a refrigerator as such they buy their meats and vegetables fresh from the market every day. Mrs.
Salvacion stated that she would usually use the leftover meat from lunch to cook the dinner meal. Mr. and Mrs.
Salvacion are both overweight, the 3rd and 4th son are normal and the 5th son and youngest daughter are both
underweight. As evidenced by their BMI the family needs to lessen or increase proper intake in order to achieve
normal BMI.
 FAMILY COPING INDEX
The purpose of this indicator is to provide a basis for estimating the nursing needs of a particular family.
It is intended to record the family’s capacity to cope rather than individual member. Coping capacity and not the
underlying problem is being rated in this indicator. The family is considered the patient.
Family Coping Index Scale:
1 – No competence 3 – Moderate Competence 5 – Complete Competence
Area Description Score Justification

(Write down observations that

support the rating given in the
area.)
1. Physical Refers to the family members’ 5 The family does not have any
Independence mobility and ability to perform difficulty moving about or do the
activities of daily living, such members need assistance to do
as feeding themselves and the Activities of Daily Living
performing activities necessary
for personal hygiene.
2. Therapeutic Refers to the family’s ability to 3 The family lacks the necessary
Competence comply with prescribed or knowledge to apply the
recommended procedures and appropriate measures accordingly.
treatments to be done at home,
which include medications,
dietary recommendations,
exercises, application of
wound dressings, and use of
prosthetic devices and other
adaptive appliances such as
wheelchairs and walkers.
3. Knowledge of Means understanding of the 1 The family does not have any clue
Health health condition or essentials or knowledge about the risk and
Condition of care according to the proper care per condition and
developmental stages of family developmental stage. They have
members. Examples are the the very basic knowledge but
degree of knowledge of knowledge cannot reach moderate
responsible family members in competence
terms of communicability of a
disease and its modes of
transmission or that a disease
is genetically transmitted, as in
the case of diabetes mellitus.
4. Application of Includes practice of general 3 The family has some form of
Principles of health promotion and general hygiene such as bathing
Personal and recommended preventive and washing of hands before
General measures. eating, but lack any more forms
Hygiene of hygiene
Refer to the family’s 5 Family is willing to have teaching
5. Health Care perception of health care in and seek professional help in
Attitudes general. This is observed in the order to solve health problems
family’s degree of
responsiveness to promotive,
preventive, and curative efforts
 of health workers.
6. Emotional Is concerned with the degree of 3
Competence emotional maturity of family
members according to their
developmental stage. This may
be observed in behaviors such
as how the family members
deal with daily challenges,
their ability to sacrifice and
think of others, and acceptance
of responsibility.
7. Family Living Refer to interpersonal
Patterns relationships among family
members
8. Physical Includes home, school, work,
Environment and community environment
that may influence the health
of family members.
9. Use of Is the ability of the family to
Community seek and utilize, as needed,
Facilities both government-run and
private health, education, and
other community services.
Family is competent in terms of
emotional state as the family
exhibited calmness and control
both through the interview and
teaching, but lack in attentiveness
and discipline
5 Family is together in nature, and
the relationships are neither
strained or pressured in any way
noticeable to the nurse
3 The physical environment of the
family, the home and community
lacks proper sanitation
3 The family actively seeks
healthcare from government and
private facilities to monitor and
help in the management of each
members health, but the family
does not use these facilities as
their “go to” or first priority
 Adventist University of the Philippines
College of Nursing

Family Health Problem

1 & 2nd Level Assessment
st

Name of Student: Name of Student Section: A

Family Health Problem Date

Problem Cues
1st Level Assessment 2nd Level Assessment
Identified Resolved
Malnutrition Subjective: Malnutrition as a 1. Inability to make decisions with respect to
Mother Verbalized “bumibili Health Deficit taking appropriate health action due to:
kami ng karne sa market araw • Low salience of the problem
araw dahil trabaho naman ng
asawa ko ay butcher.”
“minsan bumibili naman kami ng
gulay at kasama naman sya sa
karne na kinakain naming, pero
minsan naman walang gulay”

Objective:
• Family’s 24hr food recall
mainly consisted of meat
• 2 members of the family
are overweight while 2
members of the family are
underweight or
malnourished
 Adventist University of the Philippines
College of Nursing

Ranking of Family Health Problems

Summary

Name of Student:
Name of the Head of the Family:
Address:

List of Health Problems Nature of Problem (1st Level Assessment)

1.Polluted Water supply Health threat
2. Malnutrition: Underweight Health Deficit

Ranking of Health Problems of the Family

PRIORITY FAMILY PROBLEM SCORE

1ST Priority Unclean Drinking water as a health 3 1/3
threat
2nd Priority Imbalanced Nutritional intake as a 3 1/6
health Deficit
Problem _2_ : Malnutrition

Criteria Standard Score Weight Actual Justification

Score
1. Nature of the Wellness State 3 3 1 1 It is a health deficit that requires immediate management to eliminate
Problem Health Deficit 3 untoward consequences
Health Threat 2
Foreseeable 1
Crisis/Stress points
2. Modifiability of Easily 2 2 2 2 The problem is easily modifiable since the nurse’s resources are available;
the problem Partially 1 she can help the family in budgeting of money and scheduling of time;
Non-modifiable 0 she can develop the skills of other members to achieve good nutrition---
proper food selection and preparation, and feeding practices.
3. Preventive High 3 2 1 2/3 The child has 2nd degree malnutrition; mother verbalized that Grace has
Potential Moderate 2 been small in built since birth; the family is not doing anything to solve
Low 1 Grace’s nutrition problem since they do not recognize it a problem. Grace
is 6 year old and belongs to vulnerable or high risk group.
4. Salience A condition or problem, 0 1 0
needing immediate attention
Not a felt problem
2
A condition or problem not
needing immediate attention

Not perceived as a
problem 0
Total Score: 3 2/3
 HEALTH FAMILY NURSING GOAL OF CARE OBJECTIVE OF INTERVENTION PLAN
PROBLEM PROBLEMS CARE Nursing Interventions Method of Resources Required
Nurse-Family
Contact
Problem 2: 1. Inability to After nursing After nursing 1. Discuss: Home Visit Material resources:
Malnutrition make decisions intervention, Grace’s intervention, the family a. the implications of the Visual aids, examples
with respect to nutritional state will will: signs and symptoms of of food stuffs for
taking improve from second a. be able to plan and malnutrition observed in demonstrating
appropriate degree malnutrition to prepare balanced meals Grace and preparation of low-cost
health action at least first degree in which are within the b. the consequences of menus, supplies and
due to: six months’ time. family’s budget. malnutrition. equipment for cooking
• Low salience of b. feed Grace 2. Discuss with the family demonstration.
the problem according to agreed- the reasons for Grace’s
upon quantity of food malnutrition; inquire about Time and effort of the
and manner of feeding; and observe the family’s nurse and family
c. make Grace’s weight food selection and members.
increase by at least one preparation and the eating
pound per month. habits/practices of Grace. Expenses for teaching
3. Discuss with the family aids and transportation
the courses of action open to of the nurse.
them, specifically:
a. Explore the possibility of
arranging the schedule of all
members such that
responsible ones take turns in
seeing to the needs of
younger ones when Mrs.
Salvacion is not around, and
b. explore with the family
better ways of budgeting
family income
 Family Nursing Diagnosis
Health Problem Cues Goals & Objective Nursing Intervention Evaluation
1. Inability to make 1. Discuss:
Problem No.2 Subjective: decisions with Goal a. the implications of the signs and symptoms Goal Met
Malnutrition Mother verbalized, respect to taking After nursing intervention, of malnutrition observed in Grace and After six months of nursing
“Grace is really appropriate health Grace’s nutritional state will b. the consequences of malnutrition. intervention, the client
small in build since action due to: improve from second degree 2. Discuss with the family the reasons for manifested a normal weight
she was a baby. • Low salience of the malnutrition to at least first Grace’s malnutrition; inquire about and (Include the actual weight)
She is not fond of problem degree in six months’ time. observe the family’s food selection and based on early childhood
eating too…” preparation and the eating habits/practices of care and development card
Objective: Grace. for 0-6 years.
• Grace, six Objectives: 3. Discuss with the family the courses of
years old, a. Be able to plan and prepare action open to them, specifically:
weighs 10 balanced meals which are a. Explore the possibility of arranging the
kgs; looks within the family’s budget. schedule of all members such that responsible
pale, b. Feed Grace according to ones take turns in seeing to the needs of
lethargic agreed-upon quantity of food younger ones when Mrs. Salvacion is not
and and manner of feeding; around, and
apathetic; c. Make Grace’s weight b. Explore with the family better ways of
markedly increase by at least one pound budgeting family income.
underweigh per month.
t and
undernouris
hed.
 Instructional Design
Title: Tamang pagkain by yan?
Objective: Within 15 minutes of health teaching, the family will be able to relay and recall the different food groups and their purpose
Objectives Content Method of Teaching Time Allotted Evaluation

After the allotted time, • Gives our body heat and energy. Discussion with 5 minutes Simple Recall
the patient will be able to: • Foods rich in carbohydrates and pictures of the different
1. Identify foods that starchy foods such as rice, foods found in the
encompass the Go corn,bread, oatmeal, macaroni, specific food group
food group and noodles, potatoes, camote, gabi,
their purpose cassava and others.
• Food rich in sugar are cakes,
candies, honey, jam, jellies,
molasses and ice cream.

2. Identify foods that • Repairs and build our body Discussion with 5 minutes Simple Recall
are found in the cells and tissues. It makes us pictures of the different
Grow food group grow foods found in the
and their purposes • Food rich in protein are poultry specific food group
foods, meat products, eggs,
milk products, fishes, shrimps,
crabs, mongo, beans, gelatin,
soya, bean, peanuts, cereals
like rice and corn.
 3. Differentiate the • Regulate and protect our body. Discussion with 5 minutes Simple Recall
different Glow Glow foods are rich in minerals pictures of the different
foods and their and vitamins. foods found in the
purpose • Minerals rich foods are milk, specific food group
cheese, fish, shellfish, mongo
sprouts, soybeans, peanuts, egg
yolk, banana, apple, orange,
corn, rice
• Vitamin rich foods are green
leafy vegetables, yellow fruits
and vegetables, milk, cheese,
camote, kangkong, fish,
malunggay, avocado, guava

References:

(Should be APA 7th edition format)