COURSE OUTLINE: PRELIMS and manila
● Dr. Francisco de Balmis - introduced the smallpox
1. OVERVIEW OF PUBLIC HEALTH NURSING IN
THE PHILIPPINES
2. FAMILY
REFERENCE BOOK
OVERVIEW OF PUBLIC HEALTH
NURSING IN THE PHILIPPINES
GLOBAL HEALTH SITUATION
● is the health of the populations in the worldwide
context.
● the area of study, research and practice that places
a priority on improving health and achieving equity
in health for all people worldwide.
○ Pandemic
○ monkeypox
NATIONAL HEALTH SITUATION
● the condition of any unit, society, etc. the economic
health of a nation.
○ Philhealth
○ Corruption/lack of funds given by the
government
PUBLIC HEALTH
● Science and art (1) preventing disease, (2)
prolonging life, and () promoting health and
efficiency through organized community effort (C.E
Winslow)
● Connotes organized, legislated, and tax-supported
efforts that serve all people through health
departments or related governmental agencies
● Purpose: improve the health of the public by
promoting healthy lifestyles, preventing disease and
injury and protecting the health of communities
COMMUNITY HEALTH
● Global or umbrella term
PUBLIC HEALTH NURSING
● A field of professional practice in nursing and in
public health in which technical nursing,
interpersonal, analytical and organizational skills
are applied to problems
STANDARDS OF COMMUNITY HEALTH NURSING
1. Safe and quality nursing care
2. Management of resources and environment
3. Health education
4. Legal responsibility
5. Ethico Moral responsibility
a. Nonmaleficence
b. benevolence
6. Personal and professional development
a. Attend seminars, specialization
7. Quality improvement
8. Research
9. Records management
10. Communication
11. Collaboration and teamwork
HISTORY OF PUBLIC HEALTH
● 1577 - franciscan friar juan element opened a
medical dispensary in intramuros for the indigent
● 1690 - Dominican father Juan de Pergero installed
a water system in San Juan del monte (San Juan)
vaccination
● 1876- first medicos titulares were appointed as
provincial health officers
● 1888- 2 yr course consisting of fundamental
medical and dental subjects was first offered in
UST; graduates of this course served as male
nurses and sanitation inspectors (cirjuanos
ministrantes)
● 1901- US Philippine Commission, through Act 157,
created Board of Health of the Philippine Islands,
with the Commissioner of Public Health as its chief
executive officer
● The Board of Health evolved as DOH now;
eventually provincial and municipal boards of health
were formed
● 1912- Fajardo Act created sanitary divisions; each
has a “president” who had to be a physician,
sanitation inspector and a nurse
● 1915- PGH began to extend public health nursing
services in the homes of patients by organizing a
unit called Social and Home Care Service, with 2
staff nurses
● Puericulture centers were established; provided
maternity and infant care
● 1905- Asociacion Feminista Filipina founded La
Gota de Leche; the first center dedicated to the
service of motherland babies
● 1947- DOH was reorganized into bureaus
● Quarantine, hospitals that took charge of the
municipal and charity clinics, and health with
sanitary division
● 1954- RA 1082 or Rural Health Act was passed;
creation of Rural Health Unit in every municipality;
provided PHO, public health dentist in every
congressional district, MHO, PHN, midwives, and
sanitation inspectors
● 1957- RA 1891 was enacted; amended certain
provisions in the Rural Health Act
● 1970- Philippine health care delivery system was
restructured; paving the way for the healthcare
system that exists to this day where health services
are classified into primary, secondary and tertiary
● 1991- RA 7160 or the Local Government Code was
enacted devolution of basic services, including
health services to LGU and the establishment of a
local health board in every province and city or
municipality
● September 2000- Philippines signed to the UN
Millenium Declaration during the World Summit;
committed themselves to that attainment of the 8
MDGs
● 1999 - launched Health Sector Reform Agenda
● 2005 - FOURmula One (F1)
● 2010 - Universal Health Care - aims to achieve the
health system goals of better health outcomes,
sustained health financing and responsive health
systems that will provide equitable access to
healthcare.
ROLES AND RESPONSIBILITIES OF A PUBLIC
HEALTH NURSE
1. Management function
2. Supervisory function
3. Nursing care function
4. Collaborating and coordinating function
5. Health promotion and education function
6. Training function
7. Research function
WORLD HEALTH ORGANIZATION
● The United Nations agency working to promote
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 health, keep the world safe and serve the and all other health care providers in a well-defined
vulnerable. geographical area

MILLENNIUM DEVELOPMENT GOALS (MDG) NEW DOH HOSPITAL CLASSIFICATIONS 2015

1. Eradicate extreme poverty and hunger ● General Hospital
2. Achieve universal primary education ○ A hospital that provides services for all
3. Promote gender equality and empower women kinds of illnesses, diseases, injuries or
4. Reduce child mortality deformities
5. Improve maternal health ○ It provides medical and surgical care to the
6. Combat HIV/AIDS, malaria, and other diseases sick and injured, maternity, newborn and
7. Ensure environmental sustainability child care
8. Develop a global partnership for development ○ It shall be equipped with the service
capabilities needed to support board
SUSTAINABLE DEVELOPMENT GOALS (SDG) certified/ eligible medical specialists and
1. No Poverty other licensed physicians rendering
2. Zero hunger services in, but not limited to the following:
3. Good health and well-being ■ Clinical Services (Family
4. Quality education Medicine, Pediatrics, Internal
5. Gender equality Medicine, Obstetrics and
6. Clean water and sanitation ■ Gynecology, Surgery)
7. Affordable and clean energy ■ Emergency Services
8. Decent work and economic growth ■ Outpatient Services
9. Industry, innovation, and infrastructure ■ Ancillary and Support Services
10. Reduced in inequality (Clinical Laboratory, Imaging
11. Sustainable cities and communities Facility, Pharmacy)
12. Responsible consumption and production ● Specialty
13. Climate action ○ Specializes in a particular disease or
14. Life below water condition or in one type of patient
15. Life on land ○ A specialized hospital may be devoted to
16. Peace and justice strong institutions the treatment of the following:
17. Partnerships to achieve the goal ■ Treatment of a particular type of
illness or for a particular condition
DEPARTMENT OF HEALTH (DOH) requiring a range of treatment
● The Department of Health (DOH) is the principal ■ Treatment of patients suffering
health agency in the Philippines. from a particular diseases of a
● It is responsible for ensuring access to basic public particular organ or group of organ
health services to all Filipinos through the provision ■ Treatment of patients belonging
of quality health care and regulation of providers of to a group such as children,
health goods and services. women, elderly or others
● Mission: To lead the country in the development of a ● According to functional capacity
productive, resilient, equitable and people-centered ○ Level 1 General Hospital: A level 1
health system General Hospital shall have as minimum:
● Vision: Filipinos are among the healthiest people in ■ A staff of qualified, medical, allied
Southeast Asia by 2022, and Asia by 2040 medical and administrative
personnel headed by a physician
LOCAL HEALTH SYSTEM AND DEVOLUTION OF duly licensed by the PRC
HEALTH SERVICES ■ Bed space for its authorized bed
capacity, in accordance with DOH
● 1991- passage of the Local Government Code (RA
Guidelines in the Planning and
7160); all structures, personnel and budgetary
Design of Hospitals
allocations from the provincial health level down to
■ An operating room with standard
the brgy. Were devolved to the LGU to facilitate
equipment and provisions for
health service delivery
sterilization of equipment and
supplies in accordance with: DOH
OBJECTIVES Reference Plan in the Planning
1. Establish local health systems for effective and
and Design of an Operating
efficient delivery of health care services.
Room or Theater; DOH
2. Upgrade the health care management and service
Guidelines on Cleaning,
capabilities of local health facilities.
Disinfection, and Sterilization of
3. Promote inter-LGU linkages and cost sharing
Reusable Medical Devices in
schemes including local health care financing
Hospital Facilities in the
systems for better utilization of local health
Philippines
resources.
■ A post-operative Recovery Room
4. Foster participation of the private sector, NGO and
■ Maternity Facilities consisting of
communities in local health systems development.
Ward(s), Room(s), a Delivery
5. Ensure the quality of health service delivery at the
Room, exclusively for maternity
local level.
patients and newborns
■ Isolation facilities with proper
INTER LOCAL HEALTH SYSTEM procedures for the care and
● is being espoused by the DOH in order to ensure control of infection and
quality of health care service at the local level; communicable diseases as well
● It is a system of health care similar to a district as for the prevention of cross
health system in which individuals, communities infection

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 ■ A separate dental section/ clinic
■ Provision for blood donation
■ A DOH-licensed secondary
clinical laboratory with the
services of a consulting
pathologist
■ A DOH licensed Level 1 imaging
facility with the services of a
consulting radiologist
■ A DOH licensed pharmacy
■ ■ Equitable and exclusive
○ Level 2 General Hospital -As minimum,
all of Level 1 capacity, including but not
limited to:
■ An organized staff of qualified
and competent personnel with
Chief of Hospital/Medical Director
and appropriate board certified
Clinical Department Heads
■ Departmentalized and equipped
with the service capabilities
needed to support board certified/
eligible medical specialties and
other licensed physicians
rendering services in
specialties of Medicine,
Pediatrics, Obstetrics
Gynecology, Surgery, their
subspecialties, and other ancillary
services
■ Provision for general ICU for
critically ill patients
■ Provision for NICU
■ Provision for HRPU
■ Provision for Respiratory Therapy
Services
■ A DOH licensed tertiary clinical
laboratory
■ A DOH licensed level 2 imaging
facility with mobile X-ray inside
the institution and with capability
for contrast examinations
○ Level 3 General Hospital - As minimum,
all of Level 2, including but not limited to:
■ Teaching and/or Training Hospital
with accredited residency training
program for physicians in the four
major specialties namely:
Medicine, Pediatrics,
■ Obstetrics and Gynecology, and
Surgery
■ Provision for physical medicine
and rehabilitation unit
■ Provision for ambulatory surgical
clinic
■ Provision for dialysis facility
■ Provision for blood bank
■ A DOH licensed level 3 imaging
facility with interventional
radiology
○ Trauma Hospitals
■ The trauma capability of hospitals
shall be assessed in accordance
with the guidelines formulated by
the Philippine College
Surgeons
■ Trauma Capable Facility is a
DOH licensed hospital designated
as a Trauma Center
■ Trauma Receiving Facility is a
DOH licensed hospital within the
trauma service area which
receives trauma patients for
transport to the point of care or a
trauma center
PHILIPPINE HEALTH AGENDA 2016-2022
● ALL FOR HEALTH TOWARDS HEALTH FOR ALL
○ Goals:
■ Financial Protection
■ Better Health Outcomes
■ Responsiveness
○ Values
■ Uses resources efficiently
■ Transparent and accountable
■ Provides high quality services
● Lahat Para sa Kalusugan! Tungo sa Kalusugan
Para sa Lahat
○ Goals:
■ Investing in People
■ Protection Against Instability
○ Components:
■ Universal Health Coverage
■ Strengthening Implementation of
RPRH Law
■ War against drugs
the ■ Additional funds from PAGCOR
○ 3 Guarantees:
and ■ All life stages and triple burden of
disease
■ Service Delivery network
■ Universal Health Insurance
○ Strategy:
■ Advance health promotion,
primary care & quality
■ Cover all Filipinos against
financial health risk
■ Harness the power of strategic
HRH
■ Invest in eHealth and data for
decision-making
■ Enforce standards, accountability
and transparency
■ Value clients and patients
■ Elicit multi-stakeholder support for
health
PRIMARY HEALTH CARE
● September 6-12, 1978- International Conference for
Primary Health Care was held At Alma Ata, USSR;
200 countries attended; Alma Alta Declaration on
Primary Health Care emerged
● Alma Alta Declarations
○ Health is a basic fundamental right.
○ There exists global burden of health
inequalities among populations.
○ Economic and social development is of
basic importance for the full attainment of
health for all.
○ Govt’s have a responsibility for the health
of their people.
● 1979- LOI 949 was released, adopting the PHC
strategy making the Philippines the 1st Asian
country to embark on meeting the challenge of
PHC.
● What is Primary Health Care? Essential health care
of based on practical, scientifically sound and socially
acceptable methods & technology made universally
accessible to individuals and families in the
community through their full participation and at a
cost that the community & country can afford to
maintain at every stage of their dev’t in the spirit of
self-reliance & self determination
○ Universal Goal of PHC
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 ■ HEALTH FOR ALL BY THE
YEAR 2000- acceptable level of
health for all the people of the
world through community and
individual self-reliance.
■ 3 Main Objectives
● Promotion of healthy
lifestyles
● Prevention of diseases
● Therapy for existing
conditions
■ 5 Key Elements to achieving the
goal “Health for All”
● Reducing exclusion and
social disparities in
health (universal
coverage)
● Organizing health
services around people’s
needs and expectations
(health service reforms)
● Integrating health into all
sectors (public policy
reforms)
● Pursuing collaborative
models of policy
dialogue (leadership
reforms)
● Increasing stakeholder
participation.
○ Alma Alta Declaration’s 8 essential
health services
■ Education for health
■ Locally endemic disease control
■ Expanded program for
immunization
■ Maternal and child health
including responsible parenthood
■ Essential drugs
■ Nutrition
■ Treatment of communicable and
non-communicable diseases
■ Safe water and sanitation
○ Key Principles of PHC
■ Accessibility, affordability,
acceptability and availability
■ Support mechanism
■ Multisectoral approach
■ Community participation
■ Equitable distribution of health
resources
LEVELS OF PREVENTION
PRIMARY PREVENTION
● aims to prevent disease or injury before it occurs.
(Ex: legislation and enforcement to ban or control
the use of hazardous products; education about
healthy and safe habits; immunization)
SECONDARY PREVENTION
● aims to reduce the impact of a disease or injury that
has already occurred; done by detecting and
treating disease or injury as soon as possible to halt
or slow its progress (Ex: screening tests to detect
disease in its earliest stages)
TERTIARY PREVENTION
● aims to soften the impact of an ongoing illness or
injury that has lasting effects (Ex: cardiac or stroke
rehabilitation programs)
UNIVERSAL HEALTH CARE (KALUSUGANG
PANGKALAHATAN)
● Provision to every Filipino of the highest possible
quality of health care that is accessible, efficient,
equitably distributed, adequately funded, fairly
financed and appropriately used by an informed and
empowered public ( Aquino Administration)
● UHC’s Three Thrusts
○ Financial Risk Protection
○ Improved Access to Quality Hospitals and
Health Care Facilities
○ Attainment of health-related MDGs
FAMILY
● A group of persons usually living together and
composed of the head and other persons related to
the head by blood, marriage or adoption.
● A social unit interacting with the larger society.
○ Wdym by larger society? School, church,
barangay council
● Two or more persons who are joined together by
bonds of sharing and emotional closeness and who
identify themselves as being part of family.
FORMS OF FAMILY
● Nuclear- the family of marriage, parenthood, or
procreation; composed of a husband, wife, and their
immediate children-natural, adopted or both; most
common type of family
● Dyad - consisting only of a husband and wife, such
as newly married couples and “empty nesters”
● Extended Family - consisting of three generations,
which may include married siblings and their
families and/or grandparents.
● Blended family - results from a union where one or
both spouses bring a child or children from a
previous marriage into a new living arrangement.
● Compound family -where a man has more than
one spouse; approved by Phil. authorities only
among Muslims by virtue of Presidential decree no.
1083, also known as the Code of Muslim Personal
Laws of the Philippines (Office of the President,
1977)
● Cohabiting Family -described as “live in”
arrangement between an unmarried couple who are
called common-law spouses and their child or
children from such an arrangement
● Single Parent - which results from the death of
spouse, separation, or pregnancy outside of
wedlock.
● Gay/ Lesbian - made up of a cohabiting couple of
the same sex in a sexual relationship
FUNCTIONS OF THE FAMILY
● Procreation
● Socialization of family members
● Status placement - well off family → part of elite
group → status in the community
● Economic function
FAMILY AS A CLIENT
● “The family is a critical resource”
● The importance of the family in providing care to its
members has already been established. In this
caregiver role, the family can also improve
individual members’ health through health
promotion and wellness activities.
● “In a family unit, any dysfunction (illness, injury,
separation) that affects one or more family
members will affect the members and unit as a
whole”
● Referred to as the “ripple effect”, changes in one
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 member cause changes in the entire family. The ● Recognizing interruptions of health or development.
nurse must assess each individual and the family ● Seeking health care.
unit. ● Managing health and non-health crises.
● “Case Finding” ● Providing nursing care to sick, disabled, or
● While assessing an individual and family, the nurse dependent members of the family.
may identify a health problem that necessitates ● Maintaining a home environment conducive to good
identifying risks for the entire family. health and personal development.
● “Improving nursing care.” ● Maintaining a reciprocal relationship with the
● The nurse can provide better and more holistic care community and its health institutions.
by understanding the family and its members.
CHARACTERISTICS OF A HEALTHY FAMILY
FAMILY AS A SYSTEM ● Members interact with each other, they
● A way to explain how the family as a unit interacts communicate and listen repeatedly in many
with larger units outside the family and with smaller contexts.
units inside the family. ● Healthy families can establish priorities.
● Parke (2002) 3 subsystems: ● Members understand that family needs are priority.
○ Parent-child ● Healthy families affirm, support, and respect each
○ Marital other.
○ Sibling-sibling ● The members engage in flexible role relationships,
share power, and respond to change, support the
DEVELOPMENTAL STAGES growth and autonomy of others, and engage in
1. Beginning family through marriage or commitment decision making that affects them.
as a couple relationship ● The family teaches family and societal values and
2. Parenting the first child beliefs and shares a spiritual core.
3. Living with adolescents ● Healthy families foster responsibility and value
4. Launching family (youngest child leaves home) service to others.
5. Middle-aged family (remaining marital dyad to ● Healthy families have a sense of play and humor
retirement) and share leisure time.
6. Aging family (from retirement to death of both ● Healthy families have the ability to cope with stress
spouses) and crisis and grow from problems. They know
when to seek help from professionals.
FAMILY AS A SYSTEM
FAMILY COPING INDEX
1. MARRIAGE: JOINING OF FAMILIES ● tool used to assess the coping ability of the family
● Formation of identity as a couple for certain health situation with its purpose of
● Inclusion of spouse in realignment of relationships providing a basis for estimating the nursing needs
with extended families of a particular family
● Parenthood: making decisions ● A nursing need is need is present when:
○ The family has a health problem with
which they are unable to cope.
2. FAMILIES WITH YOUNG CHILDREN ○ There is a reasonable likelihood that
● Integration of children into a family unit. nursing will make a difference in the
● Adjustment of tasks: child rearing, financial and family’s ability to cope.
household ● Features:
● Accommodation of new parenting and ○ Nursing needs can be defined in terms that
grandparenting roles are in relation to the nursing intervention
that is required.
3. FAMILIES WITH ADOLESCENTS ○ Nursing needs must be based on nursing
● Development of increasing autonomy for itself.
adolescents ○ The health problem, the attitude and
● Midlife reexamination of marital and career issues knowledge of the family, the availability to
● Initial shift towards concern for the older generation. medical and hospital resources will
determine in some measure the mix of
4. FAMILIES AS LAUNCHING CENTERS nursing skills required by a particular time
● Establishment of independent identities for parents but regardless of the type of problem, the
and grown children area and the extent of nursing practice
● Renegotiation of marital relationship required can be analyzed using a single
● Readjustment of relationships to include in-laws and rubric.
grandchildren
● Dealing with disabilities and death of the older DEFINITION OF TERMS
generation. ● Coping -defined as dealing with problems
associated with care with reasonable success
5. AGING FAMILIES ● Coping deficit- when the family is unable to cope
with one and other aspect of health care
● Maintaining couple and individual functioning while
● To Cope -ability or capacity to deal with health
adapting to the aging process
situation; the control with the health competence of
● Support role of middle generation
the family
● Support and autonomy of older generation
● Preparation for my own death and dealing with the
loss of spouse/siblings and other peers. DIRECTION FOR SCALING
● A Point of the Scale
○ Enables you to place the family in relation
to their ability to cope with nine areas of
FAMILY HEALTH TASKS
the family nursing at the time observed

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 and as you would expect it to be in 3
months or at time of discharge if nursing
care were provided.
○ Scaling Cues: (limited to 3 points)
■ 1—poor competence or low
competence
■ 3—moderate competence
■ 5—high competence (complete)
○ When each of 9 categories has been
rated, the result will be a profile of family
coping capacity in relation to the family
nursing required and by the changes you
expect to occur in the course of nursing
service.
● Justification Statement - Consist of brief
statements or phrases that explain why you have
rated the family as you have expressed in terms of
behavior or observable facts rather than in
adjectives
○ Example: Unwilling to be vaccinated -
rating of 1
● General Considerations:
○ It is the coping capacity and not the
underlying problem that is being rated.
■ Example: A person with serious
cardiac condition.(do not rate this
but rather rate the family handles/
react/ address the need of that
particular patient)
○ It is the family and not the individual that is
being rated. In rating, it is your own
professional judgment that will be needed
to make a decision.
NINE AREAS OF FAMILY NURSING FAMILY
COPING INDEX
1. PHYSICAL COMPETENCE
● Concerned with the ability to move about, to get out
of bed, to take care of daily grooming, walking, etc.
● Note that it is the family competence that is
measured even though an individual is dependent,
if the family is able to compensate for this, the
family may be independent.
○ Example: stroke - members are taking turn
in taking care of the patient , family is
independent - 5
● Quality and quantity of care is important
○ If the focus of care is poor
○ It a mother is giving care to a handicapped
child that he could give himself
○ If a person is giving care that should be
shared with other members
■ These examples, independence
might be considered incomplete
● The causes of dependence may vary and may be
due to:
○ Actual physical incapacity - putol ang paa
○ The inability of “know-how” to
unwillingness; or
○ Fear of going the necessary tasks
● Family failing entirely to provide required personal
care to one or more of its members
○ Arthritic patient unable to get our of bed
alone, no one is available to help - 1
○ The patient “cannot” give his hypodermic
medication because of fear - 1
● Family providing partially for needs of its members,
or providing care for some members but not for
others - rating of 3
○ Mother may be doing well with own and
husband’s care but failing to give daily
care efficiently to a newborn baby
○ Daughter may be giving excellent physical
care to aged mother but at cost of
neglecting children somewhat, or with poor
mechanics that place undue strain upon
her
● All family members, whether or not there is infirmity
or disability in one of more of its members
○ Receiving the necessary care to maintain
cleanliness, including skin care
○ Able to get about as far as possible within
their physical abilities
○ Receiving assistance when needed
without interruption or undue delay
2. THERAPEUTIC COMPETENCE
● Includes all the procedures or treatments prescribed
for the care of illness, such as giving medication,
using appliances (including crutches), dressings,
exercises, and relaxation, special diets, etc.
● Family either not carrying out procedure prescribed
or doing it unsafely
○ Giving several medication without being
able to distinguish one from the other, or
taking them inappropriately, applying
braces so they throw the limb out of line,
measuring insulin incorrectly
○ Family resents, rejects, refuses to give
necessary care - 1
● Family carrying out some but not all of the
treatments - 3
○ Giving insulin but not adhering strictly to
diet
○ Carrying out procedure awkwardly,
ineffectively, or with resentment or
necessary anxiety
○ May be giving medication correctly, but not
understanding purposes of the drug, or
symptom to be observed
● Family able to demonstrate that the members can
carry out the prescribed procedures safely and
efficiently, with the understanding of the principles
involved and with a confident and willing attitude -
rate of 5
3. KNOWLEDGE OF HEALTH CONDITION
● Concerned with the particular health condition that
is the occasion for care
○ Knowledge of the diseases or inability to
understand the communicability of disease
and modes of transmission
○ Understanding of general pattern of
development of a newborn baby, and the
basic needs of infants for physical care or
tender loving care
● Totally uninformed or misinformed about the
condition - 1
○ Believes TB is caused by sin
○ Syphilis is cured when symptoms subside
○ Believes stroke patients must be
bedridden, and that it is cruel to make
them do something for themselves
○ Overweight in the school-age child is
“healthy”
● Has some general knowledge of the disease or
condition, but has not grasped the underlying
principles, or is partially informed - 3
○ May recognize need for tender loving care
but not relate this to placing the baby’s crib
near people when he’s awake or holding
him when feeding
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 ○ May accept fact that patient is dying but
not see need to prepare family for this
event
○ May understand dietary and insulin control
of diabetes, but not need special care of
feet, etc.
● Knows the salient fact about the disease well
enough to take necessary action at the proper time,
understands the rationale of care, able to observe
and report significant symptom - 5
4. APPLICATION OF PRINCIPLE OF GENERAL
HYGIENE
● Concerned with family action in relation to
maintaining family nutrition, securing adequate rest
and relaxation for family members, carrying out
accepted preventive measures such as
○ Immunization
○ Medical appraisal
○ Safe homemaking habits in relation to
storing and preparing foods
● Family diet grossly inadequate or unbalanced,
necessary immunization not secured for children - 1
○ House dirty, food handles in unsanitary
way
○ Members of the family working beyond
reasonable limits
○ Children and adults getting too little sleep
○ Family members unkempt, filthy
○ Inadequately clothed in relation to weather
● Failing to apply some general principles of hygiene–
for instance 3
○ Keeping house in excellent condition but
expending too much energy and becoming
over fatigue as a result
○ Secured initial immunication
○ General riot and homemaking skills good,
but father carrying two full-time jobs
● Household runs smoothly, family meals well
selected; habits of sleep and rest adequate to
needs - 5
5. HEALTH ATTITUDE
● Concerned with the way the family feels about
health care in general, including preventive service,
care of illness and public health measures
● Family resent and resist all health care - rating of 1
○ Has no confidence in doctors
○ Uses patent medicines and quack
nostrums
○ Feels illness is unavoidable and to be
home rather than treated
○ Feels community health agencies should
no interfere or bother them
○ Practice folk medicines or superstitious
rites of illness
● Accepts healthcare in some degree but with
reservations- rating of 3
○ May accept for medical care for illness but
not general preventive measure
○ May have confidence in doctors generally,
but not in the clinic or in “free” doctors
○ May feel certain illnesses are hopeless
(such as cancer), or care unnecessary –
for instance dental care for the young child
● Understands and recognizes need for medical care
in illness and for the usual preventive services -
rating of 5
○ Arranges for periodic physical appraisals
and follow through with recommendations
○ Accepts illness calmly and recognizes the
limits it imposes while doing all possible to
effect recovery and rehabilitation.
6. EMOTIONAL COMPETENCE
● This category has to go with the maturity and
integrity with which the members of the family are to
meet the usual stresses and problems of life, and to
plan for happy and fruitful living
○ The degree to which individuals accept the
necessary disciplines imposed by one’s
family and culture
○ The development and maintenance of
individual responsibility and decision
○ Willingness to meed responsibility and
decision
○ Willingness to meet a reasonable
obligations, to accept adversity with
fortitude, to consider the needs of others
as well as one’s own
● Family does not face realities - score of 1
○ Assumes moribund patient will get well,
that an unwanted pregnancy isn’t sp
○ One or more members lacking in
emotional control - uncontrollable ranges
○ Irresponsible sexual activities
○ One or more members are alcoholic
○ Family torn, suspicious of one another
○ Evidence of great insecurity, guilt and
anxiety
● Family members usually do fairly well, but one or
more members evidence lack of security or maturity
-3
○ Thumb sucking in late childhood
○ Unusual concern with that the neighbors
will think
○ Failure to plan ahead for foreseeable
emergencies
○ Leaving children unattended
○ “Fighting” in the family on occasion
● All members of the family able to maintain a
reasonable degree of emotional calm, face up to
illness realistically and hopefully - 5
○ Able to discuss problems and difference
with objectivity and reasonable emotional
control
○ Do not worry unduly and trivial matters
○ Consider the needs and wishes of other
family members, of neighbors and those
with whom they work and live in making
decisions upon action.
7. FAMILY LIVING
● Concerned largely with the interpersonal or group
aspects of family life
○ How well the members of the family get
along with one another
○ The ways in which they make decisions
affecting the family as a whole
○ The degree to which they support one
another and do the things as a family
○ The degree of respect and affection they
show for one another
○ The ways in which they manage the family
budget
○ The kind of discipline that prevails
● Family consists of a group of individuals indifferent
or hostile to one another, so strongly dominated and
controlled by a single family member - rating of 1
● No control of children or family to totally dependent
on one another that they are being stifled
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 ○ Mother developing habits of dependence
in sons thereby threatening future capacity
for independence in own family lige
○ No rational plan for managing available
money
○ “Battered” child
● Family gets along but has habits or customs that
interfered with the unity of the family - 3
○ A family bond of one another have many
home activities but is dominated by a
father in a kindly way
○ Recreational habits separated members of
the family much of the time
○ Children somewhat overprotected
○ Parent’s expectations of their children are
sometimes unrealistic – parents expect
children with low academic competence to
become successful professionals
● Family does things together, each member acts for
the good of the family as a whole - 5
○ Children respect parents and vice versa
○ Family tasks shared, evidence of planning
○ Leaving children without any supervision
while the mother works
○ Failing to take steps to register for public
housing when available
○ Using resources inappropriately, for
example, calling an ambulance or using
emergency services for minor injuries
● Family is aware of and uses some, but not all the
available community resources that they need - rate
of 3
○ The family may be under welfare care and
seeks the assistance of the social worker
responsible. But on the other hand,
overlooks the help that could be extended
to them by the school counselors or the
spiritual guidance the church can provide
● Uses the facilities they need appropriately and
promptly - rate of 5
○ Knows when and whom to call for help
○ Feels secure in their relationship with
community workers such as social
workers, teachers, doctors, etc.

8. PHYSICAL ENVIRONMENT
● This topic is concerned with the home, the
community and the work environment as it affects
family health
● The condition of the house such as the:
○ Presence of accident hazards, screening,
plumbing system, facilities for cooking and
privacy
○ Level of community (deteriorated
neighborhood, presence of social hazards
such as rats), transportation, condition of
schools and availability
● House in poor condition- unsafe, unscreened,
poorly ventilated - rating of 1
● Neighborhood deteriorated- juvenile and adult
delinquency, no recreational space except streets -
rating of 1
● House needs some repair or painting but is
fundamentally sound - rating of 3
● Neighborhood with some undesirable social
elements but possible to protect children from poor
social influence through education and other
community activities - rating of 3
● House crowded but adjustments can be made - 3
● House in good repair - 5
● Provides for privacy and is free of accidents and
pest hazards - 5
● Neighborhood respectable and provided with
recreational facilities for children - 5
● Free from undesirable social elements - 5
● Opportunities for the community - 5

9. USE OF COMMUNITY FACILITIES

● This category has to do with the degree of family
use and awareness of the available community
facilities for health education and welfare
● This includes the ways in which they would use the
services of private physicians, clinics, hospitals,
schools, welfare organizations, churches, and so
forth
● The coping ability does not indicate the level of the
need for services, but rather the degree to which
they can cope when they must seek such aid
● Family has obvious and serious social needs but
has not sought or found any help - rate of 1
○ A family may be borrowing unreasonable
sums of money for medical care, instead of
availing of the free hospitals or clinic

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