FAMILY NURSING ASSESSMENT

I. Family Structure, Characteristics and Dynamics

A. Demographic Data

Family Members
Position in Name of Age Sex Civil Date of Birth Place
the Family the Status Birth
Member

B. Family Structure

1. Based on Internal Organization

2. Based on Place of Residence

3. Based on Authority

a. General Family relationship or Dynamics

b. Communication Pattern

II. Socio-Economic and Cultural Characteristics

A. Demographic Data

Member of Educational occupation Place of Income Ethnic Religious

the Family attainment Work Background Affiliation

Total Family Income

B. Expenses

FOOD

CLOTHING

ELECTRICITY

WATER SUPPLY
 MEDICINE

TELEPHONE

3CELL PHONE

EDUCATIONAL EXPENSES

OTHER EXPENSES

Total Expenses__________

Estimated amount of expenses every day.

III. Home and Environment

A. Housing
1. Housing Condition
2. Type of Housing
3. Housing Status
4. Housing Arrangement
Living room
Kitchen and Dining room
Bedroom
Backyard
Terrace
No. of Bedroom
No Toilet

Appliances Living Dining Family Kitchen Backyard Terrace Garage Bedroom

Available Room Room Room

Remarks:
5. Resting sites for vector of diseases

Mosquitoes
Roaches
Flies
Dogs
Chicken
6. Presence of Accident Hazard
B. Sanitation
1. Water Supply
a. Source
b. Potability
2. Toilet Facility
 a. Type of Toilet
Ex: Latrine
b. Sanitary Condition
3. Garbage Disposal System
a. Types of Garbage Disposal
b. Garbage Collection
4. Drainage System
C. Health Facilities
Hospital
Health Center
D. Communication and Transportation Facilities
1. Communication Facilities
2. Transportation Facilities

IV. Health Status

A. Family Medical Status

Past/Present Father Mother S3 S4 S5

Illness/Death
Asthma
Bleeding
tendency
Diabetes
Drug
Addiction
Hypertension
Malaria
Mental
Disorder
Tuberculosis
Cancer
Congenital
Abnormality
Heart
Disease
Other Lung
Disorder
Nutritional
disorder
Paralysis
UTI
Migraine
Others
None

B. Family beliefs and practices

1. Use of herbal Medicine
2. consultation of a faith healer
3. consultation to a health professional
4. health center
5. self medication
 C. Nutrition
Father Mother S1 S2 S3 S4
Weight
Height
Daily Food Intake
a. rice Daily Intake
b. Fish Always
c. Meat Occasionally
d. Vegetables Always
e. Fruits Sometimes
Fluid Intake Always
D. Feeding Habits for Babies

V. Values and Practices on Health Promotion/ maintenance and Disease Prevention

A. Immunization Status of each member

FAMILY MEMBER Status
Father

B. Healthy Lifestyle Practices

Taking a bath daily
Regular brushing of teeth
C. Adequacy of :
Sleep and rest
Exercise/ activities
D. Preventive Health Service
Family Planning ( )
E. Ways of living that are deterrent to health

11. Data Analysis

1. FAMILY STRUCTURE, CHARACTERISTICS AND
DYNAMICS
2. SOCIO ECONOMICAND CULTURAL
CHARACTERISTICS
3. HOME AND ENVIRONMENT

F. HOUSING (Housing Condition, Type of housing, housing

Status, Housing Arrangement
G. SANITATION
Water supply
Toilet Facility
Garbage disposal system
Drainage system
Resting sites for vector of diseases
Presence of accident hazards
H. HEALTH FACILITIES
I. COMMUNICATION AND TRANSPORTATION
FACILITIES
4. HEALTH STATUS
5. VALUES AND PRACTICES ON HEALTH PROMOTION /
MAINTENANCE / AND DISEASE PREVENTION

PHYSICAL EXAMINATION
(Individual PA of family members)
FAMILY NURSING CARE PLAN
(at least 3 in each student)

DOCUMENTATION
STUDENT PROFILE

DE LA SALLE LIPA
COLLEGE OF NURSING
 FOCUS
AREA: COMMUNITY HEALTH NURSING

CONCEPT: Family Health Care Nursing

GENERAL OBJECTIVE: The Related Learning Experience of the level ___

nursing students in the community was designed to facilitate the learning and
provide family health care utilizing accurately the family Health Care Process.

SPECIFIC OBJECTIVES:
1. Using the family assessment guide forms students should be able to
comprehensively assess the families in terms of demographic data, home and
home environment details, health and health practices, awareness on
community resources and organizations.
2. Help the family recognize the problem
3. Assist the family to cope effectively with the health problems by increasing
its capacity to perform the health tasks.
4. Facilitate learning that involves reducing the health risks factors; improve
family’ s level of wellness and providing information about specific
protective
health measures.
5. Identify relevant family nursing diagnosis and plan activities to address the
identified problems.
6. Implement nursing actions and develop outcome criteria to evaluate family
health care services rendered.
7. Formulate alternative plans if the evaluation result is negative.
8. Identify community health problems and categorize according to health
related community problem or health resources.
9. Analyze the problems and determine the resources needed.
10. Prepare a community Health Action Plan

A TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING

PRACTICE

FIRST LEVEL ASSESSMENT

I. Presence of health threats, health deficits and foreseeable crisis or stress points
in the family.
A. HEALTH THREATS- conditions that are conducive to disease, accident or
failure to realize one’ s health potential.
Ex.
 1. Health history of specific condition or disease (diabetes)
2. Threat of cross infection from a communicable disease case
3. Family size beyond what family resources can adequately
provide
4. Accident hazards
5. Nutritional
6. Stress provoking factors
7. Poor environmental sanitation
8. unsanitary food handling and preparation
9. personal habits and unhealthy lifestyle practices
10. Inherent personal characteristics (short temper)
11. health history which may precipitate/ induce the occurrence of
a health deficit (history of a difficult labor)
12. Inappropriate role assumptions
13. Inadequate immunization status
14. Family disunity
15. others specify____________
B. HEALTH DEFICITS- instance of failure in health maintenance
Ex.
1. Illness states, regardless whether it is diagnosed or undiagnosed by a
medical health practitioner.
2. Failure to thrive or develop according to normal rate
3. Disability arising from an illness, whether transient or temporary
(temporary paralysis from a CVA or leg amputation secondary to
diabetes)
C. STRESS POINTS/ FORESEEABLE CRISIS SITUATIONS – anticipated
periods of unusual demand on the individual or family in terms of adjustment
or family resources.
Ex.
1. marriage
2. pregnancy, labor or puerperium
3. parenthood
4. additional member
5. abortion
6. entrance at school
7. adolescence
8. loss of job
9. hospitalization or death of a member
10. resettlement ina new community
11. illegitimacy
12. others specify ___________

SECOND LEVEL ASSESSMENT

II. Inability to recognize the presence of the problem due to:
1. Ignorance of facts
2. Fear of consequences of diagnosis of problem (social stigma)
3. attitudes or philosophy in life
4. others specify ___________
III. Inability to make decisions with respect to taking appropriate health action
due to:
1. Failure to comprehend the nature, magnitude/ scope of the
problem
2. low salience of the problem
3. feeling of confusion and/ resignation brought about by failure to
brake down problems into manageable units of attack
4. lack of knowledge or insights as to alternative courses of action
open to them
5. Inability to decide which action to take from among a list of
alternatives
6. conflicting opinions among family members/ significant others
regarding action take
7. Ignorance of community resources for care
8. Fear of consequences of action
9. negative attitude towards the health problem
10. Inaccessibility of appropriate resources of care
11. lack of trust or confidence to the health personnel or agency
12. Misconception or erroneous information about proposed
course(s) of action

IV. Inability to provide adequate nursing care to the sick, disabled, dependent or
vulnerable at risk member of the family due to:
1. Ignorance of facts about the disease/ health condition (nature,
severity, complications, prognosis and management) child
development and child care
2. Ignorance of the nature and extent of nursing care needed
3. Lack of the necessary facilities (equipment and supplies) for
care
4. Lack of knowledge and skill in carrying out the necessary
treatment/ procedure/ care
5. Inadequate family resources for care
6. negative attitude towards the sick, disabled, dependent,
vulnerable at risk member
7. attitude or philosophy in life
8. members preoccupied with own concerns and interests

VI. Inability to provide a home environment which is conducive to health

maintenance and personal development due to
1. Inadequate family resources
2. Failure to see benefits of investment in home environment
improvement
3. Ignorance of importance of hygiene and sanitation
4. Ignorance of preventive measures
5. Lack of skill in carrying out measures to improve home
environment
6. Ineffective communications patterns
 7. Attitude or philosophy in life
VII. Failure to utilize community resources for health care due to
1. Ignorance or lack of awareness of community resources for
health care
2. Failure to perceive the benefits of health care services
3. lack of trust in the agency or personnel
4. previous unpleasant experience with health worker
5. fear of consequence of action
6. unavailability of required care/ services
7. inaccessibility of required care or services
8. lack or inadequate family resources
9. feeling of alienation to or lack of support from the
community
10. attitude or philosophy in life