COMMUNITY HEALTH NURSING 1: INDIVIDUAL

AND FAMAND FAMILY \

PRELIM – BSN 1K SY 2022-2023 – MS. GLENDA LYNNE TITUAN FRONTERAS

directed behavior, competent self-care, and

COMMUNITY satisfying relationships with others.”
- Community is seen as a group or
collection of locality-based individuals, OLOF (MODIFIED FROM BLOOM 2000)
interacting in social units and sharing common - Ecosystem Factors (modified from blum
interests, characteristics, values, (2000))
and/or goals.  Socio-economic status
a. Allender - “a collection of people who interact - Employment
with one another and whose common - Education
interests or characteristics form the basis for a - Housing
sense of unity or belonging.  Hereditary factor -> genetic
b. Lundy and Janes - “ a group of people who - Generic endowment
share something in common and - Defects
interact with one another, who may exhibit a - Strengths
commitment with one another and may - Risks
share geographic boundary.” - Familial
c. Clark - “a group of people who share common - Ethnic
interests, who interact with each - Racial
other, and who function collectively within a  Health care delivery system
defined social structure to address - Promotive
common concerns.” - Preventive
d. Shuster and Goeppinger - “a locality-based - Curative
entity, composed of systems of formal - Rehabilitative
organization reflecting society’s institutions,  Activities and behavior
informal groups and aggregates. - Culture
- Habits
TWO MAIN TYPES OF COMMUNITY
- Mores
 Geopolitical communities
- Ethnic customs
- Also called territorial communities.
 Political factors
- Are most traditionally recognized
- Safety
- Defined or formed by both natural and
- Oppression
man-made boundaries and include
- People empowerment
barangays,municipalities, cities, provinces, regions,
 Environmental factors
and nations.
- Air
 Phenomenological communities
- Food
- Also called functional communities.
- Water waste
- Refer to relational, interactive groups in
- urban/rural
which the place or setting is more abstract,
- Noise
and people share a group perspective or identity
- Radiation
based on culture, values, history,
- Pollution
interest and goals.

DEFINITION OF HEALTH WHAT IS NURSING

a. WHO - “a state of complete physical, mental
and social well-being and not merely the
absence of disease or infirmity”
b. Murray - “a state of well-being in which the
person is able to use purposeful,
adaptive responses and processes physically,
mentally, emotionally, spirituality and
socially.”
c. Pender - “actualization of inherent and
acquired human potential through goal-
- Assisting sick individuals to become
healthy and healthy individuals to achieve optimum
wellness.
WHAT IS CHN
- The synthesis of nursing practice and
public health practice applied to promoting and
preserving health of the populations American
Nurse Association(ANA), 2018.
- Encompasses subspecialties that include
public health nursing, occupational health nursing,
and other developing fields of practice, such as
home, health, hospice care, and independent nurse
practice
- Maglaya et al is the standard definition of
CHN in the Philippines
- According to Maglaya et al, the utilization
of nursing process in the different levels of clientele,
individual, family, community and population
groups concerned with the:
- Promotion of health
- Prevention of disease
- Disability and Rehabilitation
WHAT IS PUBLIC HEALTH NURSING (PHN)
- The term used before for CHN (broader
and includes independent nursing practice)
ULTIMATE GOAL:
- “To raise the level of health citizenry”
- To enhance the capacity of individuals,
families and communities to cope with their health
needs.
- To give health teachings.
COMMUNITY BASED NURSING
- Application of the nursing process in
caring for individuals, families and groups where
they live, work, go to school or they move through
the healthcare system.
- Setting-specific such as home health
nursing
COMMUNITY HEALTH NURSING vs.
COMMUNITY-BASED NURSING
 Community Health Nursing
- Emphasizes preservation and protection
of health
- Whole
- Primary client: community.
 Community-based Nursing
- Emphasizes on managing acute and
chronic
- Specific
- Primary client: individual and the family
POPULATION-FOCUSED NURSING
- Concentrates on specific groups of people
and focuses on health promotion and disease
prevention, regardless of geographical location
- Focused practice:
1. Focuses on the entire population
2. Based on assessment of the
population’s health status
3. Considers the broad determinants
of health
4. Emphasizes all levels of prevention
5. Intervenes with communities,
systems, individuals, and families,
3 IMPORTANT ELEMENTS
1. POPULATION-BASED/FOCUSED
- Population-focused nursing care means
providing care based on the greater need of the
majority of the population
2. 3 LEVELS OF CLIENTELE (IFC)
- Individual
- Family (basic unit of care)
- Community (patient)
3. IDENTIFIES AND DEFINE 12 PUBLIC HEALTH
INTERVENTIONS SURVEILLANCE
 Surveillance - monitors health events
 Disease and other health event
investigation
 Outreach - locates populations at risk
 Screening - identifies individuals with
unrecognized health risk factors
 Case finding - identifies risk factors and
connects them with resources
 Referral and follow up - assist to
identify and access necessary resources
 Case management - optimizes self care
capabilities of individuals with families.
 Delegated functions - direct care tasks
that the nurse carries out.
 Health teaching - communicates acts,
ideas and kills that change knowledge,
attitudes, values behaviors and
practice.
 Counseling - establishes an
interpersonal relationship with the
intention of increasing or enhancing
their capacity for self-care and coping .
 Consultation - seeks information and
generates optimal solutions to
perceived problems
 Collaboration - commits two or more
persons or an organization
 Coalition building - develops alliances
among organizations
 Community organizing - helps
community groups to identify common
problems or goals mobilizes resources
and develop and implement strategies
 Advocacy - pleads someone's cause or
acts on someone behalf
 Social marketing - utilizes commercial
marketing principles for programs
 Policy development and enforcement
- place issues on decision makers
agendas, acquire plans of resolution.
FAMILY
- Basic unit of society/community.
- Values, beliefs, and customs of society
influence the role and function of the family
(invades every aspect of the life of the family)
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 - Provides a set of functions important to  Foster
the needs of the individual members and to society - Substitute family for children whose
as a whole parents are unable to care for them
- Provides the individual with the necessary
environment for the development FUNCTIONAL TYPE
- Provides new and socialized members of  Family of Procreation
the society - Refers to the family you yourself created
- Burgess and Locke (1992): family is a  Family of Orientation
group of persons united by ties of marriage, blood -Refers to the family where you came from
or adoption.
- Duvall (1971): family is a unity of BASED ON RESIDENCE
interacting persons related by ties of marriage,  Patrilocal
birth or adoption, wo’s central purpose is to create - The married couple live with or near the
and maintain a common culture which promotes husband’s family
the physical, mental, emotional, and social  Matrilocal
development of each of its members. - The husband leaves his family and sets up
- Friedman (2003): family is composed of housekeeping with or near his wife’s family.
2 or more people who are joined together by bonds  Neolocal
of sharing and emotional closeness and who - The married couple establish a new home
identify themselves as being part of the family. - They reside independently of the parents
of either groom or bride.
TYPES OF FAMILY  Bilocal
ACCORDING TO STRUCTURE: - Gives the couple a choice of staying with
 Nuclear either the groom’s parents or the bride’s parents.
- A father, mother with child/children living
together but apart from both parents and other BASED ON DECISION IN THE FAMILY
relatives. (AUTHORITY):
 Extended  Patriarchal
- Composed of two or more nuclear families - Full authority on the father or any male
economically and socially related to each other, member of the family
- Multigenerational, including married brothers and - Ex: eldest son, grandfather
sisters, and their families.  Matriarchal
 Single Parent - Full authority of the mother or any female
- Divorced or separated, unmarried or member of the family.
widowed male or female with at least one child. - Ex: eldest sister, grandmother
 Blended/Reconstituted  Egalitarian
- A combination of two families with - Husband and wife exercise a more or less
children from both families and sometimes children amount of authority, father and mother decides
of the newly married couple. It is also a remarriage  Democratic
with children from a previous marriage. - Everybody is involve in decision making
 Compound  Autocratic
- One man/woman with several spouses - Full authority
 Communal  Laissez-faire
- More than one monogamous couple - Full autonomy
sharing resources.  Matricentric
 Cohabiting/live-in - The mother decides/takes charge in
- Unmarried couple living together absence of the father
 Dyad - Ex: father is working overseas
- Husband and wife or other couple living  Patricentric
alone without children. - The father decides/takes charge in the
 Gay/Lesbian absence of mother
- Honosexual couple living together with or
without children
 No-kin
- A group of at least two people sharing a
relationship and exchange support who have no
legal or blood tie to each other.

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FAMILY NURSING PROCESS
- Is the blueprint in the care that the nurse
design to systematically minimize or eliminate
the identified health and family nursing
problems through explicitly formulated
outcomes of care (goals and objectives) and
deliberately chosen set of interventions,
resources, and evaluation criteria, standards
and tools.
- A systematic approach of solving an
existing problem/meeting the needs of family
- Rapport
- Assessment
- Planning
- Intervention
- Evaluation
I. RAPPORT
- trust building
- knowing your client
- Adjusting to the situation end
environment
- RESPECT
II. ASSESSMENT
A. First major of nursing process
B. Involves a set of action by which the nurse
measures the status of the family as a client. Its
ability to maintain wellness, prevent, control or
resolve problems in order to achieve health and
wellness among its members
C. Data about present condition or status of the
family are compared against the norms and
standards of personal, social, and environmental
health, system integrity and ability to resolve social
problems
D. The norms and standards are derived from
values, beliefs, principles, rules or expectation
 Data Collection Methods: Select Appropriate
Method
- Observation
- The family’s health status can be
inferred from the s/sx prob;em areas
a. communication and
interaction
patterns expected, used, and tolerated by family
members
b. role perception/task
assumption
by each member including decision making
patterns
c. conditions in the home and
environment
- Physical examination
-Significant data about the health
status of the individual members can be
obtained through direct examination
through IPPA
- Measurement of specific body parts and
reviewing the body systems
- Data gathering from P.E form substantial
first level assessment which may indicate the
presence of health deficits (illness status)
- Interview
- Productivity of interview process depends
upon the use of effective communication
techniques to elicit needed response of PROBLEMS
ENCOUNTERED
- Records review
- e.g. laboratory or diagnostic tests)
- Gather information through
reviewing existing records and reports
pertinent to the client
- Individual clinical records of the
family members, laboratory and diagnostic
records, immunization records report about
house and environmental condition
TYPOLOGY OF NURSING PROBLEMS
 First level assessment
- To determine problems of family
- Sources of problems using IDB
- Family: use of Initial Data Base (IDB)
- Nature: health deficit (HD), Health threat
(HT), foreseeable crisis (FC)
 Second level assessment
- Defines the nature or type of nursing
problem that family encounters in performing
health task with respect to given health condition
or problem and etiology or barriers to the family’s
assumption of task.
TOOLS FOR ASSESSMENT
 IDB (Initial Data Base)
 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


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 Socio-economic and cultural factors
1. Income and expenses
- Occupation, place of work and income of
each working member
- Adequacy to meet basic necessities (food,
clothing, shelter)
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
 Home and Environment Factors
- Information in housing and sanitation
facilities, kind of neighborhood and availability of
social, health, communication and transportation
facilities.
1. Housing
- Adequacy of living space
- Sleeping in arrangement
- Presence of breathing or resting sites of
vector of diseases (mosquitos, roaches, flies,
rodents, etc.)
- Presence of accident hazard
- Food storage and cooking facilities
- Water supply-source, ownership, pot
ability
- Toilet facilities-type, ownership, sanitary
condition
- Garbage/refuse disposal-type, sanitary
condition
- Drainage system type, sanitary condition
- Adequacy of living space:
Formula:
TFA (in sqm) = Length of the House X Width
of the House
TSR = Number of Household Members X
Corresponding Space required for that Member
Consider:
- Adults (13 y/o and above) = 15
sqm
- Children (1 y/o to 12 y/o) = 8 sqm
- Infants (Below 12 months) = 0 sqm
Compare the TFA (Total Floor Area) with
the TSR (Total Space Requirement)
Crowded if: TFA<TSR
Not Crowded if: TFA>TSR
Example:
TFA = 21 sqm
TSR= 2(15) + 3(8)
30+24
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Interpretation: TFA<TSR (Crowded)
TYPES OF MATERIALS USED FOR HOUSE
 Light
- Refers to such materials as bamboo, nipa,
sawali, coconut leaves, or card board
 Strong
- Refers to predominantly concrete house
 Mixed
- Refers to a combination of light materials
wood and or concrete
- Typically floor and foundation and light
walls or a concrete 1st floor and a light 2nd floor
 Light Facilities
- Artificial means of providing
light/illumination
- Facilities used already reflect adequacy
and safety for the family
- Example: electricity, kerosene, candles or
none
APPROVED TYPE OF WATER FACILITIES
 Level 1 (Point Source)
- A protected well or a developed spring
with an outlet but without a distribution system
- Indicated for rural areas where houses are
scattered
- Serves 15-25 household; its outreach is
not more than 250m from the farthest user
- Yields 40-140L/m
 Level 2 (Communal Faucets or Stand Posts)
- With a source, reservoir, piped
distribution network and communal faucets
- Located at not more than 25m from the
farthest house
- Delivers 40-80L of water per capital per
day to an average of 100 households
- Serves 4-6 household per faucet
- Fit for rural areas where houses are
densely clustered
 Level 3 (Individual House Connections or
Waterworks System)
- With a source, reservoir, piped
distribution network and household taps
- One or more faucets per household
- Fit for densely populated urban
communities
TYPE OF EXCRETA DISPOSAL
 LEVEL 1
 Non water carriage toilet facility
- No water necessary to flush the waste into
the receiving space
- Example: pit l;atrine, bored-hole latrines
 Toilet facilities requiring small amount of
water to wash the waste into the receiving space
- Example: pour flush toilet and aqua privies
 Pail system
- A pail or box is used to receive toe excreta
and suppose later when filled
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 - (included ballot system where in excreta is
wrapped in a piece of paper/plastic and thrown
later)
 Open pit privy/latrine
- Consist of a pit covered with a platform
with a hole and is usually not covered
- The platform may, in its simplest form
consist only of 2 pieces of wood or bamboo
 Closed pit privy/ latrine
- A pit privy in which the hole over the
platform is provided with a cover
 Type of Pit include:
 Ventilation improved pit (VIP)
- Pit with a vent pipe
 Reed odorless earth closet (ROEC)
- A pit completely displaced from the
superstructure and connected to the squatting plate
by a curved plate chute
- A variation of VIP latrine
- Pit fully “off-set” from superstructure,
and connected to squatting slab wit a “curved chute”
- connected with vent pipe to control
odor and insect nuisance
- it is claimed that the chute, in
conjunction with the ventilation stack, encourages
vigorous air circulation down the latrine, thereby
removing odors and discouraging flies. This type of
latrine is common in Southern Africa.
 Antipolo type
- Toilet house is elevated and the shallow
pit is extended upwards to the platform (toilet floor)
by means of a chute or pipe made of metal, clay
aluminum or board
 Bored-hole latrine
- Toilet consist of a deep (usually more than
10 feet) but relatively narrow (less than 2 meters in
diameter) hole made with boring equipment
 Overhung latrine
- Toilet house is constructed over a body of
water (stream, lake, and river) into which excreta is
allowed to fall freely.
 LEVEL 2
- On site toilet facilities of the water
carriage type with water-sealed type with water-
sealed and flush type with septic vault/tank
disposal.
 Flush type
- A toilet system where waste is disposed by
flushing water through the pipes(sewers) into the
public sewerage system or into an individual
disposal system like an individual septic tank
 Water sealed latrine
- An antipolo type of toilet, bored-hole
latrine, or any pit privy wherein water sealed toilet
bowl is placed instead of the simple platform hole
(+) septic tank
 LEVEL 3
- Water carriage types of toilet facilities
connected to septic tanks and/or to sewerage
system to treatment plant
SEWERGE SYSTEM
 Blind drainage - waste water flows through a
system, of closed pipes to an underground pit
or covered canal
 Open drainage - waste water flows through a
system of pipes (could be improvised from
bamboo) to an open pit canal
 None - when no drainage system or container
used for garbage. Waste water from the kitchen
flows directly to the ground, oftentimes
forming a nearly permanent pool. Garbage is
not put in a container when disposed
TYPES OF WASTE DISPOSAL
 Hog feeding - garbage is used as hog feed and
also to chicken and other livestock
 Open dumping - refuse and/or garbage piled
in a dumping place (with or without pit) with no
soil covering
 Open burning - regularly piles
refused/garbage and later burned in open air. This
is uncontrolled burning which is usually done for
yard and street sweeping. It may be allowed in
rural areas where it will not worsen already
existing air pollution.
 Burial pit - refuse/garbage placed in a pit and
covered when filled up. There is no intention to dig
it up later for use as fertilizer. This should be
located 25 meters away from any well used for
water supply.
 Composting - involved buying or stacking of
alternating layers of organic based refuse/garbage
and treated soil arranged as to hasted rapid decay
and decomposition into compost. This organic
mixture can later be used as fertilizer
 Garbage collection - refuse/garbage collected
by truck and any type of garage collected in the
community
HOME AND ENVIRONMENT
- Information on housing and sanitation
facilities, kind of neighborhood and availability of
social, health, communication and transportation
facilities
1. Housing
2. Kind of neighborhood, e.g. congested, slum etc.
3. Social and health facilities available
4. Communication and transportation facilities
available
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 HEALTH STATUS OF EACH FAMILY MEMBERS
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)
- 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 is equal
to or greater than 90 cm in men and greater than
80 cm in women),
- Waist hip ratio (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)
- Dietary history specifying quality
and quantity of food or nutrient intake per
day
- Eating/feeding habits/practice
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.
VALUES HEALTH PRACTICES ON HEALTH
PROMOTION, MAINTENANCE AND DISEASE
PREVENTION
1. Immunization status of family members
2. Healthy lifestyle practices
3. Specify 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
TOOLS USE IN FAMILY HEALTH ASSESSMENT
 Family health assessment form
- Is a guide in data collection, as a means to
record pertinent information about the family that
will assist the nurse in working with family.
 Genogram
- Helps the nurse outline the family’s
structure. It is a way to diagram the family. Three
generations of family members are included with
symbols denoting genealogy.
 Ecomap
- A classic tool that is used to depict a
family’s linkages to its suprasystem.
- Portrays an overview of the family in their
situation; it depicts the important nurturant of a
conflict laden connection between the family and
the world. It demonstrates the flow of resources or
the lacks and deprivation.
- A mapping procedure that highlights the
nature of the interfaces and points to conflicts to be
mediated, bridges to built, and resources to be
sought and mobilized.
TYPOLOGY OF NURSING PROBLEMS IN FAMILY
NURSING PRACTICE
 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 if 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 clinical data BUT NO explicit
expression of desire to achieve a higher level of
state or function in a specific area on health
promotion and maintenance.
 Readiness for enhanced wellness state
- Is a nursing judgment on wellness state or
condition based on client’s performance, or
condition base on client’s current competencies or
performance clinical data or explicit expression if
desire to achieve a higher level of state or function
in a specific area on health promotion and
maintenance
A. Presence of Wellness condition
1. Healthy lifestyle - e.g. nutrition/diet,
exercise/activity
2. Health 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____
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B. Readiness for enhanced capability for:
1. Healthy lifestyle - e.g. nutrition/diet,
exercise/activity
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
- Family is health but there are risks
Hazards
Inadequate/lack of communication
Cross infection
Environmental sanitation is poor
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. Inherit 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
1. Self-oriented behavior of member
(members)
2. Unresolved conflicts of members
3. Intolerable disagreement
O. Others. Specify
III. Presence of health deficits
- Instances of failure in health maintenance
- If identified problem is an abnormality,
illness or diseases, there’s a gap/difference
between normal status (ideal, desirable, expected)
& actual statues (the outcome/result/problem
encountered on the actual day
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, blindness from measles, lameness
\from polio)
- Disease, disorder, disability,
developmental.
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IV. Presence of stress points/foreseeable crisis
situations
- Are anticipated periods of unusual
demand on the individual or family in terms of
adjustment/family resources.
- Anything which is anticipated/expected to
become a problem
- School Entrance
- Adolescents
- Courtships
- Circumcision
- Illegitimacy
- Pregnancy
- Death
- Addiction
Examples of this include:
A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
- newborn, lodger
E. Abortion
F. Entrance at school
G. Adolescence
H. Divorce or separation
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
 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
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 break down 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._________
III. 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
the 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,
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vulnerable/at risk member 2. Financial consequences
I. Member’s preoccupation with on 3. Social consequences
concerns/interests F. Unavailability of required care/services
J. Prolonged disease or disabilities, which G. Inaccessibility of required services due to:
exhaust supportive capacity of family members. 1. Cost constraints
K. Altered role performance, specify. 2. Physical inaccessibility
1. Role denials or ambivalence H. Lack of or inadequate family resources,
2. Role strain specifically
3. Role dissatisfaction 1. Manpower resources, e.g. baby sitter
4. Role conflict 2. Financial resources, cost of medicines
5. Role confusion prescribe
6. Role overload I. Feeling of alienation to/lack of support
L. Others. Specify._________ from the community
- e.g. stigma due to mental illness, AIDS, etc
IV. Inability to provide a home environment J. Negative attitude/philosophy in life which
conducive to health maintenance and personal hinders effective/maximum utilization of
development due to: community resources for health care
A. Inadequate family resources specifically: K. . Others, specify.
Financial constraints/limited financial resources
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 adequate competencies in relating
to each other for mutual growth and maturation
- Example: 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._________

V. 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
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