Develop an interview questionnaire to be used in a family-focused functional assessment.

The
questionnaire must include three open-ended, family-focused questions to assess functional health
patterns for each of the following:

 Values/Health Perception
1. What cultural and/or religious beliefs does your family like to be honored during medical
care?
2. What values are important to your family?
3. What is your family’s medical history?
4. Does each family member have a primary care doctor that they see yearly?
 Nutrition
1. What is a typically dinner for your family?
2. Are there any dietary restrictions and if so what does your family eat instead?
3. Does your family read nutritional labels and aware of their daily nutritional intake?
 Sleep/Rest

m
1. What is your family’s nightly bedtime routine?

er as
2. How many hours does your family typically sleep each night?

co
3. Does your family have any barriers that restrict them from getting adequate sleep each

eH w
night?

o.
 Elimination

rs e
1. Does your family have any digestive or urinary issues?
ou urc
2. Does each member of your family have regular bowel movements?
3. How would your family deal with constipation?
 Activity/Exercise
o

1. How often does your family exercise?

aC s

2. What type of physical activities does your family participate in?

vi y re

3. Does anyone in your family have a physically issue and/or past injuries that prevents
them from getting adequate exercise?
 Cognitive
1. What is the highest level of education each family member has?
ed d

2. Are there any learning barriers and/or difficulties?

ar stu

3. What is your family’s preferred method of learning about their own health? Medical
diagnosis?
 Sensory-Perception
is

1. Does any member of your family have hearing and/or vision issues?
2. What is your family’s preferred method of pain control?
Th

3.
 Self-Perception
1. Does anyone in the family suffer from mental illness or emotional difficulties?
sh

2. How do you perceive others see your family?

3. Where do you see your family in five years from now?
 Role Relationship
1. Who is the primary financial provider within the home?
2. How are family duties split amongst each family member?
3. How does your family communicate amongst themselves?

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  Sexuality
1. What is your method for teaching your children about sex?
2. What are your family’s beliefs on sex?
3. Do you teach your children about safe sex and safety measure when having sex?
 Coping
1. How does each family member cope with stress?
2. What is your family’s preferred method of solving problems?
3. Describe your family’s support system

m
er as
co
eH w
o.
rs e
ou urc
o
aC s
vi y re
ed d
ar stu
is
Th
sh

This study source was downloaded by 100000833454822 from CourseHero.com on 10-05-2021 11:26:02 GMT -05:00

https://www.coursehero.com/file/62868345/familyquestionsdocx/
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