COR JESU COLLEGE, INC.

Tres de Mayo, Digos City 8002, Davao del Sur

Tel No. 553-9714/ Fax No. (082) 553-2433

Course Title: Community Health Nursing (Individual and Family)

Course No.: NCM 104
Learning Outcome: 1. Assess with the individual and family one’s health
status/competence.
2. Formulate with the client a plan of care to address the
health conditions, needs, problems and issues based on
principle.
3. Implement safe and quality interventions with the
client to address the health needs, problems and issues.
4. Provide health education using selected planning
models to targeted clientele (individuals and families) in
the community.
Content:

Module 5: FAMILY NURSING PROCESS (2 HOURS)

Topic 1: Family Health Assessment
Topic 2: Family Nursing Diagnosis

Topic 1: Family Health Assessment

Concept/Digest
Family Health Assessment
• This involves a set of actions by which the status of a family as client, its
ability to maintain itself as a system and functioning unit, and its ability to
maintain wellness, prevent, control, or resolve problems in order to achieve
health and well-being among its members are measured.

ASSESSMENT PHASE
• Nursing assessment is the first major phase of the nursing process.
• In family health nursing practice, this involves a set of actions by which the
nurse measures the status of the family as a client, its ability to maintain
itself as a system and functioning unit, and its ability to maintain wellness,
prevent, control or resolve problems in order to achieve health and well-
being among its members.
 • Nursing assessment includes:
1. Data collection
2. Data analysis or interpretation a
3. Problem definition or nursing diagnosis
• Nursing diagnosis is the end result of two major types of nursing
assessment in family nursing practice based on the framework used in
this book.
• These are:
1. First-level assessment
• First-level assessment is a process whereby existing and potential
health conditions or problems of the family are determined.
• These health conditions or problems are categorized as:
I. Wellness statels
II. Health threats
III. Health deficits
IV. Stress points or foreseeable crisis situations (see Table 3).
2. Second-level assessment-
• Operationally defined, Second-level assessment, on the other hand,
defines the nature or type of nursing problems that the family
encounters in performing the health tasks with respect to a given
heart condition or problem, and the etiology or barriers to the family's
assumption of these tasks.

STEPS IN FAMILY NURSING ASSESSMENT

• There are three major steps in nursing assessment as applied to family
nursing practice. Figure 1 illustrates these steps.
Data collection for first level assessment
• involves gathering of five types of data which will generate the categories
of health conditions or problems of the family.
• These data include:
1. Family structure, characteristics and dynamics;
2. Socio-economic and cultural characteristics;
3. Home and environment;
4. Health status of each member,
5. Values and practices on health promotion/maintenance and disease
prevention.

Second-level assessment data

• include those that specify or describe the family's realities, perceptions
about and attitudes related to the assumption or performance of family
 health tasks on each health condition or problem identified during the first
level assessment.

Data analysis involves several sub-steps:

1. Sorting of data for broad categories such as those related with the health
status or practices of family members or data about home and
environment;
2. Clustering of related cues to determine relationships between and among
data;
3. Distinguishing relevant from irrelevant data to decide what information is
pertinent to understanding the situation at hand and what information is
immaterial;
4. Identifying patterns such as physiologic function, developmental,
nutritional/dietary, coping/adaptation or communication patterns and
lifestyle;
5. Comparing patterns with norms or standards of health, family functioning
and assumption of health tasks;
6. Interpreting results of comparisons to determine signs, symptoms or cues of
specific wellness state/s, health deficit/s, health threat/s or foreseeable
crisis/stress point/s and their underlying causes or associated factors;
7. Making inferences or drawing conclusions about the reasons for the
existence of the health condition, problem, risk factor/s related to non
maintenance of wellness state/s which can be attributed to
nonperformance of family health tasks.

• The last step in family nursing assessment involves making a diagnosis.

• This includes two types:
1. The definition of wellness state/potential or health condition or problems
as an end product of first- level assessment,
2. The definition of family nursing problems as an end result of second level
assessment. The family nursing problem is stated as an inability to
perform a specific health task and the reasons (etiology) why the family
cannot perform such task.

DATA COLLECTION
• The nurse is concerned about two important things to ensure effective and
efficient data collection in family nursing practice.
• Firstly, she has to identify the types or kinds of data needed.
• Secondly, she needs to specify the methods of data-gathering and the
necessary tools to collect such data.

Types of Data in Family Nursing Assessment

• What data are needed to arrive at a measure of the family's ability to
achieve health and well-being among its members, while it maintains
itself as a system and as a functioning unit?
• There are two types of data needed at two levels of assessment in family
nursing practice.
 • The following constitute the first type of data (initial data base) taken
during the first-level assessment:
1. Family structure, characteristics and dynamics
2. Socio-economic and cultural characteristics
3. Home and environment
4. Health status of each member
5. Values and practices on health promotion/maintenance and
disease prevention

• A tool for gathering this initial data base (IDB) is presented in Table 2.
• Through this IDB, the nurse can identify existing potential wellness
state/s, health threats, health deficits and stress points/foreseeable
crises a given family.
• The other type of data taken during the second level assessment
reflects the extent to which the family form the health tasks on each
health condition or problem identified. These data include:
1. The family's perception of the problem;
2. Decisions made and appropriateness; if none, reasons
3. Actions taken and results; if none, reasons;
4. Effects of decisions and actions on other family members.

Data-gathering Methods and Tools

• There are several methods of data-
gathering that the nurse can select from
depending on availability of resources
such as material, manpower, time and
facilities.
• To illustrate, a combination of interview,
observation, ocular survey, direct examination (physical assessment), use
of laboratory or diagnostic tests and record review can be utilized to
generate first-level assessment data using the tool in Table 2, Initial Data
Base for Family Nursing Practice.
• The following are brief descriptions of common methods of gathering data
about a family, its health status and state of functioning:
1. Observation
• This method of data collection is done
through the use of the sensory
capacities -- sight, hearing, smell and
touch.
• The family's health status can be
inferred from signs and symptoms of
problem areas reflected in the
following:
a. Communication and interaction
patterns expected, used, and
tolerated by family members.
 b. Role perceptions/task assumptions by each member including
decision-making patterns,
c. Conditions in the home and environment.
2. Physical Examination
• Significant data about the
health status of individual family
members can be obtained
through direct examination.
• Data generated from
physical assessment form a
substantive part of first-level
assessment which may indicate presence of health deficits (illness
states).
3. Interview
• Another major method of data-gathering is the interview.
a. Completing a health history for each family member.
o The health history determines current health status based on:
▪ significant past health history
▪ e.g., developmental accomplishments, known illnesses,
allergies, restorative treatment, residence in endemic
areas for certain diseases or exposures to
communicable diseases;
o Family history
▪ e.g. genetic history in relation to health and illness
o Social history
▪ e.g., intrapersonal and interpersonal factors affecting
the family member's social adjustment or vulnerability to
stress and crisis (Stone-Clemen, Eigsti, McGuire 1991,
p.271).
b. Collecting data by personally asking significant family members
or relatives questions regarding health, family life experiences and
home environment to generate data on what wellness condition
and health problems exist in the family (First-level Assessment, See
Table 3) and the corresponding nursing problems for each health
condition or problem (Second-level Assessment, Table 3).
Second level assessment can be adequately done for each wellness state, health
threat, health deficit or crisis situation by going through the to lowing procedures:
a. Determine if the family recognizes the existence of the condition
or problem. If the family does not recognize the presence of the
condition or problem, explore the reasons why.
o Sample interview questions:
i. What do you think about the condition of your ... ?(Ano ang
palagay ninyo sa kalagayan ng inyong ... ?)
ii. What do you think is the reason why he appears ... (e.g. thin,
lethargic)? Or, Why do you think he is behaving this way ...
? (Ano sa palagay ninyo ang dahilan kung bakit siya
nagkakaganyan?)
 iii. What do you think is happening to your ...? (Ano sa palagay
ninyo ang nangyayari sa inyong ...?) nd he
b. If the family recognizes the presence of the condition or problem,
determine if something has been done to maintain the wellness
state or resolve the problem. If the family has not done anything
about it, determine the reasons why. If the family has done
something about the problem or condition, determine if the
solution is effective.
o Sample interview questions:
i. What have you done to improve the condition or situation?
(Ano na ang nagawa ninyo para magbago ang
kalagayan ... o mapaigi ang pakiramdam ... ?).
ii. What are your plans regarding this? (Ano ang inyong mga
binabalak tungkol dito?)
iii. What improvements in the condition of ... have been
observed? (Anong mga pagbabago ang inyong napansin
sa kalagayan ni ... ?)
c. Determine if the family encounters other problems in implemente
ing the interventions for the wellness state/potential, health threat,
health deficit or crisis. What are these problems?
o Sample interview questions:
i. What were the problems or barriers encountered in ...?
(Anu-ano ang inyong naging problema sa pagpapatupad
ng mga solusyon sa ... ?, or Anu-ano ang mga naging
sagabal o balakid nang inyong ginawa ang ... ?)
ii. What do you think are the reasons why there is no
improvement in the condition of ...? (Anu-ano sa palagay
ninyo ang dahilan kung bakit walang pagbabago ang
kalagayan ni ...?)
iii. Why did you stop doing what you used to do regarding ...?
(Bakit ninyo itinigil o hindi ipinagpatuloy ang dati ninyong
ginagawa sa...?
iv. Why did you not continue doing what we have discussed
regarding ...? (Bakit hindi ninyo ipinagpatuloy ang ating
pinag-usapan tungkol sa ...?)
v. How did you do it? (Papaano ninyo ginawa ito?); or, How
often did you do it? (Gaano ninyo kadalas ginawa ito?)
d. Determine how all the other members are affected by the wellness
state/potential, health threat, health deficit or stress point.
o Sample interview questions:
i. How are the other members affected by...? (Ano ang
nagging epekto ng... sa ibang miyembro ng pamilya?);
ii. How are the other members reacting to...? (Ano ang
nagging reaksyon ng ibang miyembro ng pamilya sa..?)

4. Record Review
 • The nurse may gather information through reviewing existing records
and reports pertinent to the client.

5. Laboratory/Diagnostic Tests
• Another method of data collection is through performing laboratory
tests, diagnostic procedures, or other tests of integrity and functions
carried out by the nurse herself and/or other health workers.

DATA ANALYSIS
• Utilizing the data generated from the tool on Initial Data Base in
Family Nursing Practice (See Table 2), the nurse goes through data
analysis.
• The standards or norms utilized in determining the status of the family
as a client or patient can be classified into three types:
1. Normal health of individual members
• Involves the physical, social, and emotional well-being of each
family member
2. Home and environmental conditions conducive to health
development
• Include both the physical as well as the psychological milieu.
Such a milieu considers the type and quality of housing
adequacy of living space, adequacy of facilities both in the
home and the community, the kind of neighborhood,
environmental sanitation, psychological or socio-cultural
norms, values, expectations or modes of life which enhance
health de and prevent or control risk factors and hazards.
3. Family characteristics, dynamics or level of functioning
conducive to family development
• Constitutes the client's ability as a system to integrity and
achieve its purposes through a dynamic interchange member
while responding to the external multi-environments along a
time continuum.
In order to achieve wellness among its members and reduce or eliminate health
problems, the standard or norm of the family as a functioning unit involves the
ability to perform the following health tasks:
1. Recognize the presence of a wellness state or health condition or
problem;
2. Make decisions about taking appropriate health action to
maintain wellness or manage the health problem;
3. Provide nursing care to the sick, disabled, dependent or at-risk
members;
4. Maintain a home environment conducive to health maintenance
and personal development;
5. Utilize community resources for health care.

After comparison of patterns with norms or standards, assessment data as

categorized or reorganized are interpreted, and inferences are drawn. The end
result of this analysis during the first-level assessment is a conclusion, a definition of
a wellness state or health condition or problem classified as a wellness potential,
health threat, health deficit or stress point/foreseeable crisis. This definition
constitutes any of the following:
1. Transition state from a specific level of wellness to a higher level.
2. Medical or nursing diagnosis indicating current health status of a family
member.
3. Condition of home and environment conducive to disease/illness
accidents
4. Maturation/developmental or situational crisis situation.
• The second-level of analysis ends with a definition of family nursing
problems. To define family nursing problems each wellness state or health
con or problem must be analyzed in terms of how the family handles it.
• The process of data gathering for this analysis has been described earlier
(see Interview. Methods of Gathering Data).

NURSING DIAGNOSES: FAMILY NURSING PROBLEMS

• The end result of the second-level assessment is a set of family nursing
problems for each health condition or problem.

A wellness condition - is a nursing judgment related with the client's capability for
wellness.
A health condition or problem- is a situation which interferes with the promotion
and/or maintenance of health and recovery from illness or injury.
A wellness state or health condition/problem - becomes a nursing problem when
it is stated as the family's failure to perform adequately specific health tasks to
enhance the wellness state or manage the health problem.
• This is called the nursing diagnosis in family nursing practice.
• One of the major barriers to the effective operationalization and
application of the nursing process in family health care is the absence of a
classification system for nursing problems that reflect the family status and
capabilities as a functioning unit.
• This tool, called A Typology of Nursing Problems in Family Nursing Practice
(see Table 3), has been used by nursing students, community health nurse
practitioners and educators.

• Through the years revisions have been done to ensure all-inclusiveness and
mutual exclusiveness of the list. The most recent update includes wellness
diagnoses (2003).

The Typology of Nursing Problems in Family Health Care

• The organizing principle of the typology is Freeman's family health tasks.
• A community health nurse works with and through the family to improve its
behavior related to health.
• The typology contains six main categories of problems in family nursing
care (see Table 3).
• The first category refers to the presence of wellness states, health threats,
health deficits and foreseeable crisis situations or stress points.
 • The result of the analysis of data taken during the first-level assessment
(utilizing the tool Initial Data Base for Family Nursing) is reflected as of health
condition or problems, either a wellness state heal or foreseeable
crisis/stress point.
• After identifying these, the nurse determines the family's ability to perform
the five health tasks on each of these three types of health conditions or
problems.
• The remaining five main categories of problems contain statements of the
family's incapabilities in the assumption health tasks.
• The results of the analysis of data taken during the 2nd level assessment is
reflected as statements of the family nursing problems.
• There are five main types, namely:
1. Inability to recognize the presence of the condition/problem due to…
2. Inability to make decisions with respect to taking appropriate health
action due to...
3. Inability to provide nursing care to the sick, disabled or dependent
member of the family due to...
4. Inability to provide a home environment which is conducive to health
maintenance and personal development due to...
5. Failure to utilize community resources for health care due to...

• This is parallel to the concepts of immediate cause, intermediate cause

and ultimate cause when identifying the cause(s) of morbidity or mortality,
or Mundinger and Jauron's concept of a nursing diagnosis (Mundinger and
Jauron 1975, pp. 96-97). According to the latter, a nursing diagnosis consists
of two parts:
1. The statement of the unhealthful response; and,
2. The statement of factors which are maintaining the undesirable
response and preventing the desired change.

• The more specific the problem definition (which depends on the depth and
breadth of the assessment), the more useful is the nursing diagnosis in
determining nursing intervention.
• Therefore, as many as three or four levels of problem definition can be
stated.
• To illustrate, in a family with a prenatal patient who is at the same time the
breadwinner of the family and who is not receiving any care/supervision,
the nursing problem may be stated as:

(General) Inability to utilize community resources for health care due to lack of
adequate family resources, specifically

(Specific) a. financial resources

b. manpower resources
c. time
Table 2. Initial Data Base for Family Nursing Practice
A. Family Structure Characteristics and Dynamics
1. Members of the household and relationship to the head of the family.
2. Demographic data-age, sex, civil status, position in the family
3. Place of residence of each member-whether living with the family or
elsewhere
4. Type of family structure-e.g. patriarchal, matriarchal, nuclear or
extended
5. Dominant family members in terms of decision making especially on
matters of health care
6. General family relationship/dynamics-presence of any
obvious/readily observable conflict between members;
characteristics, communication/interaction patterns among
members.
B. Socio-economic and Cultural Characteristics
1. Income and expenses
a. Occupation, place of work and income of each working
member
b. Adequacy to meet basic necessities (food, clothing,
shelter)
c. Who makes decision about money and how it is spent
2. Educational Attainment of each Member
3. Ethnic Background and Religious Affiliation
4. Significant others-role (s) they play in family’s life
5. Relationship of the family to larger community-nature and extent of
participation of the family in community activities

C. Home Environment
1. Housing
A. Adequacy of living space
B. Sleeping in arrangement
C. Presence of breathing or resting sites of vector of diseases (e.g.
mosquitoes, roaches, flies, rodents, etc.)
D. Presence of accident hazard
E. Food storage and cooking facilities
F. Water supply-source, ownership, pot ability
G. Toilet facilities-type, ownership, sanitary condition
H. Garbage/refuse disposal-type, sanitary condition
I. Drainage System-type, sanitary condition
2.Kind of Neighborhood, e.g. congested, slum etc.
3.Social and Health facilities available
4.Communication and transportation facilities available

D. Health Status of Each Family Member

 1.Medical Nursing history indicating current or past significant illnesses or
beliefs and practices conducive to health and illness
2.Nutritional assessment (especially for vulnerable or at risk members)
a. Anthropometric data: measures of nutritional status of children-
weight, height, mid-upper arm circumference; risk assessment
measures for obesity : body mass index(BMI=weight in kgs. divided by
height in meters2), waist circumference (WC: greater than 90 cm. in
men and greater than 80 cm. in women), waist hip ration
(WHR=waist circumference in cm. divided by hip circumference in
cm. Central obesity: WHR is equal to or greater than 1.0 cm in men
and 0.85 in women)
b. dietary history specifying quality and quantity of food or nutrient per
day
c. Eating/ feeding habits/ practices
3.Developmental assessment of infant, toddlers and preschoolers- e.g.
Metro Manila Developmental Screening Test (MMDST).
4.Risk factor assessment indicating presence of major and contributing
modifiable risk factors for specific lifestyle diseases-e.g. hypertension,
physical inactivity, sedentary lifestyle, cigarette/ tobacco smoking,
elevated blood lipids/ cholesterol, obesity, diabetes mellitus, inadequate
fiber intake, stress, alcohol drinking, and other substance abuse.
5.Physical Assessment indicating presence of illness state/s (diagnosed or
undiagnosed by medical practitioners )
6.Results of laboratory/diagnostic and other screening procedures
supportive of assessment findings.

E. Values, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention. Examples include:
1. Immunization status of family members
2. Healthy lifestyle practices. Specify.
3. Adequacy of:
• Rest and sleep
• Exercise/activities
• Use of protective measure-e.g. adequate footwear in parasite-
infested areas; use of bed nets and protective clothing in malaria
and filariasis endemic areas.
▪ Relaxation and other stress management activities
4.Use of promotive-preventive health services

FIRST LEVEL ASSESSMENT

I. Presence of Wellness Condition-stated as potential or Readiness-a clinical
or nursing judgment about a client in transition from a specific level of
wellness or capability to a higher level. Wellness potential is a nursing
judgment on wellness state or condition based on client’s performance,
current competencies, or performance, clinical data or explicit expression
of desire to achieve a higher level of state or function in a specific area on
health promotion and maintenance. Examples of this are the following
A. Potential for Enhanced Capability for:
1. Healthy lifestyle-e.g. nutrition/diet, exercise/activity
2. Healthy maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being-process of client’s developing/unfolding of
mystery through harmonious interconnectedness that comes from
inner strength/sacred source/God (NANDA 2001)
6. Others. Specify.
B. Readiness for Enhanced Capability for:
1. Healthy lifestyle
2. Health maintenance/health management
3. Parenting
4. Breastfeeding
5. Spiritual well-being
6. Others. Specify.

II. Presence of Health Threats-conditions that are conducive to disease and

accident, or may result to failure to maintain wellness or realize health
potential. Examples of this are the following:
A. Presence of risk factors of specific diseases (e.g. lifestyle diseases,
metabolic syndrome)
B. Threat of cross infection from communicable disease case
C. Family size beyond what family resources can adequately provide
D. Accident hazards specify.
1. Broken chairs
2. Pointed /sharp objects, poisons and medicines improperly kept
3. Fire hazards
4. Fall hazards
5. Others specify.
E. Faulty/unhealthful nutritional/eating habits or feeding
techniques/practices. Specify.
1. Inadequate food intake both in quality and quantity
2. Excessive intake of certain nutrients
3. Faulty eating habits
4. Ineffective breastfeeding
5. Faulty feeding techniques
F. Stress Provoking Factors. Specify.
1. Strained marital relationship
2. Strained parent-sibling relationship
3. Interpersonal conflicts between family members
4. Care-giving burden
G. Poor Home/Environmental Condition/Sanitation. Specify.
1. Inadequate living space
2. Lack of food storage facilities
 3. Polluted water supply
4. Presence of breeding or resting sights of vectors of diseases
5. Improper garbage/refuse disposal
6. Unsanitary waste disposal
7. Improper drainage system
8. Poor lightning and ventilation
9. Noise pollution
10. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal Habits/Practices. Specify.
1. Alcohol drinking
2. Cigarette/tobacco smoking
3. Walking barefooted or inadequate footwear
4. Eating raw meat or fish
5. Poor personal hygiene
6. Self medication/substance abuse
7. Sexual promiscuity
8. Engaging in dangerous sports
9. Inadequate rest or sleep
10. Lack of /inadequate exercise/physical activity
11. Lack of/relaxation activities
12. Non use of self-protection measures (e.g. non use of bed nets in
malaria and filariasis endemic areas).
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 Role Assumption- e.g. child assuming mother’s role, father
not assuming his role.
M. Lack of Immunization/Inadequate Immunization Status Specially of
Children
N. Family Disunity-e.g.
1. Self-oriented behavior of member(s)
2. Unresolved conflicts of member(s)
3. Intolerable disagreement
O. Others. Specify._________

III. Presence of health deficits-instances of failure in health maintenance.

Examples include:
A. Illness states, regardless of whether it is diagnosed or undiagnosed by
medical practitioner.
B. Failure to thrive/develop according to normal rate
C. Disability-whether congenital or arising from illness; transient/temporary
(e.g. aphasia or temporary paralysis after a CVA) or permanent (e.g. leg
amputation secondary to diabetes, blindness from measles, lameness
from polio)
IV. Presence of stress points/foreseeable crisis situations-anticipated
periods of unusual demand on the individual or family in terms of
adjustment/family resources. Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
I. Menopause
J. Loss of job
K. Hospitalization of a family member
L. Death of a member
M. Resettlement in a new community
N. Illegitimacy
O. Others, specify.___________

SECOND-LEVEL ASSESSMENT
I. Inability to recognize the presence of the condition or problem due to:
A. Lack of or inadequate knowledge
B. Denial about its existence or severity as a result of fear of consequences
of diagnosis of problem, specifically:
1. Social-stigma, loss of respect of peer/significant others
2. Economic/cost implications
3. Physical consequences
4. Emotional/psychological issues/concerns
C. Attitude/Philosophy in life, which hinders recognition/acceptance of a
problem
D. Others. Specify _________

II. Inability to make decisions with respect to taking appropriate health

action due to:
A. Failure to comprehend the nature/magnitude of the problem/condition
B. Low salience of the problem/condition
C. Feeling of confusion, helplessness and/or resignation brought about by
perceive magnitude/severity of the situation or problem, i.e. failure to
breakdown problems into manageable units of attack.
D. Lack of/inadequate knowledge/insight as to alternative courses of
action open to them
E. Inability to decide which action to take from among a list of alternatives
F. Conflicting opinions among family members/significant others regarding
action to take.
G. Lack of/inadequate knowledge of community resources for care
H. Fear of consequences of action, specifically:
1. Social consequences
2. Economic consequences
 3. Physical consequences
4. Emotional/psychological consequences
I. Negative attitude towards the health condition or problem-by negative
attitude is meant one that interferes with rational decision-making.
J. In accessibility of appropriate resources for care, specifically:
1. Physical Inaccessibility
2. Costs constraints or economic/financial inaccessibility
K. Lack of trust/confidence in the health personnel/agency
L. Misconceptions or erroneous information about proposed course(s) of
action
M. Others specify._________

IV. Inability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable/at risk member of the family due to:
A. Lack of/inadequate knowledge about the disease/health condition
(nature, severity, complications, prognosis and management)
B. Lack of/inadequate knowledge about child development and care
C. Lack of/inadequate knowledge of the nature or extent of nursing care
needed
D. Lack of the necessary facilities, equipment and supplies of care
E. Lack of/inadequate knowledge or skill in carrying out the necessary
intervention or treatment/procedure of care (i.e. complex therapeutic
regimen or healthy lifestyle program).
F. Inadequate family resources of care specifically:
1. Absence of responsible member
2. Financial constraints
3. Limitation of luck/lack of physical resources
G. Significant persons unexpressed feelings (e.g. hostility/anger, guilt,
fear/anxiety, despair, rejection) which his/her capacities to provide care.
H. Philosophy in life which negates/hinder caring for the sick, disabled,
dependent, vulnerable/at risk member
I. Member’s preoccupation with on concerns/interests
J. Prolonged disease or disabilities, which exhaust supportive capacity of
family members.
K. Altered role performance, specify.
1. Role denials or ambivalence
2. Role strain
3. Role dissatisfaction
4. Role conflict
5. Role confusion
6. Role overload
L. Others. Specify._________

V. Inability to provide a home environment conducive to health

maintenance and personal development due to:
A. Inadequate family resources specifically:
1. Financial constraints/limited financial resources
2. Limited physical resources-e.i. lack of space to construct facility
B. Failure to see benefits (specifically long term ones) of investments in
home environment improvement
C. Lack of/inadequate knowledge of importance of hygiene and
sanitation
D. Lack of/inadequate knowledge of preventive measures
E. Lack of skill in carrying out measures to improve home environment
F. Ineffective communication pattern within the family
G. Lack of supportive relationship among family members
H. Negative attitudes/philosophy in life which is not conducive to health
maintenance and personal development
I. Lack of/inadequate competencies in relating to each other for mutual
growth and maturation (e.g. reduced ability to meet the physical and
psychological needs of other members as a result of family’s
preoccupation with current problem or condition.
J. Others specify._________

VI. Failure to utilize community resources for health care due to:
A. Lack of/inadequate knowledge of community resources for health care
B. Failure to perceive the benefits of health care/services
C. Lack of trust/confidence in the agency/personnel
D. Previous unpleasant experience with health worker
E. Fear of consequences of action (preventive, diagnostic, therapeutic,
rehabilitative) specifically :
1. Physical/psychological consequences
2. Financial consequences
3. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
1. Cost constrains
2. Physical inaccessibility
H. Lack of or inadequate family resources, specifically
1. Manpower resources, e.g. baby sitter
2. Financial resources, cost of medicines prescribe
I. Feeling of alienation to/lack of support from the community, e.g. stigma
due to mental illness, AIDS, etc.
J. Negative attitude/ philosophy in life which hinders effective/maximum
utilization of community resources for health care
K. Others, specify __________

Learning Activities:
1. Assess a family (other than your own) that you know well by completing a
family assessment guide. You may use one of the forms in this chapter or an
available form from another source. Based on your assessment, determine
as many nursing interventions as you can think of that could be used to
promote this family’s health as practically as possible.
2. Invite a peer to go on a family health visit with you, and be open to
feedback regarding your strengths and weaknesses. How does it make you
feel to have someone else on a family health visit with you, knowing they
 are observing your skills? Offer to do the same for a peer and provide him
with feedback. Discuss your experience.
3. Go on several family-health visits with an experienced community health
nurse and observe the nurse’s visiting techniques. Observe how he contacts
the family, knocks on the door, greets the family, conducts, summarizes,
and concludes the visit, and makes plans for the next visit. Discuss the
various techniques used, and ask questions about your observations to get
a better idea of why things are done as they are. Use some of this
information on your next home visit.