TYPES OF DATA NEEDED
● Health statues of each family member
○ Developmental assessment of
infant, toddlers and preschoolers
■ Eg. Metro Manila
Developmental Screening
Test (MMDST)
○ Risk factor assessment indicating
presence of major and contributing
modifiable risk factors for specific
lifestyle diseases
○ Physical assessment indicating
presence of illness states
■ Diagnosed or undiagnosed
by medical practitioners
○ Result of laboratory / diagnostic and
other screening procedures
● BMI categories
○ Underweight = <18.5
○ Normal weight = 18.5 - 24.9
○ Overweight = 25 - 29.9
○ Obesity = BMI of 30 or greater
● Waist circumference
● Values, habits, practices on health
promotion, maintenance and disease
prevention
○ Immunization status
○ Healthy lifestyle practices
○ Use of promotive-preventive health
services
○ Adequacy of:
■ Rest and sleep
■ exercise/activities
■ Use of protective measures
e.g adequate footwear in
parasite infested areas
TOOLS FOR ASSESSMENT
Method of data gathering
● Observation
○ Done through use of sensory
capacities
● Physical examination
○ significant data about the health
status of individual members can be
obtained through direct examination
through IPPA, Measurement of
specific body parts and reviewing
the body systems
● Interview
○ Productivity of interview process
depends upon the use effective
communication techniques to elicit
needed response
● Record review
○ Gather information through
reviewing existing records and
reports pertinent to the client
● laboratory/ diagnostic tests
Genogram
● Is a tool that helps the nurse outline the
family’s structure
● Generally, includes three generations of
family members
● Children are pictured from left to right,
beginning with the oldest child
Family Health Tree
● Provides a mechanism for recording the
family’s medical and health histories
● Can be used in planning positive familial
influences on risk factors
● Such as diet, exercise, coping with stress,
or pressure to have physical examination
Ecomap
● Can be used to depict family’s linkages to
its suprasystems (Hartman, 1979)
FAMILY HEALTH ASSESSMENT
Data Collection
● Plan for data collection
● Data collection methods and techniques
Data Analysis
● First level assessment
○ Categorize the problems
■ Health threat
■ Health deficit
■ Foreseeable crisis/stress
points
Diagnosis
● Second level assessment
TYPOLOGY OF NURSING PROBLEMS IN
FAMILY NURSING PRACTICE
First Level Assessment
I. Presence of Wellness Condition / Wellness
potential
● 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.
A. Potential for Enhanced Capability for:
a. Healthy lifestyle-e.g. nutrition/diet,
exercise/activity
b. Healthy maintenance/health
management
c. Parenting
d. Breastfeeding
e. Spiritual well-being-process of
client’s developing/unfolding of
mystery through harmonious
interconnectedness that comes from
inner strength/sacred source/God
(NANDA 2001)
f. Others. Specify.
B. Readiness for Enhanced Capability for:
a. Healthy lifestyle
b. Health maintenance/health
management
c. Parenting
d. Breastfeeding
e. Spiritual well-being
f. 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.
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.
a. Broken chairs
b. Pointed /sharp objects, poisons and
medicines improperly kept
c. Fire hazards
d. Fall hazards
e. Others specify.
E. Faulty/unhealthful nutritional/eating habits or
feeding techniques/practices. Specify.
a. Inadequate food intake both in
quality and quantity
b. Excessive intake of certain nutrients
c. Faulty eating habits
d. Ineffective breastfeeding
e. Faulty feeding techniques
F. Stress Provoking Factors. Specify.
a. Strained marital relationship
b. Strained parent-sibling relationship
c. Interpersonal conflicts between
family members
d. Care-giving burden
G. Poor Home/Environmental
Condition/Sanitation. Specify
a. Inadequate living space
b. Lack of food storage facilities
c. Polluted water supply
d. Presence of breeding or resting
sights of vectors of diseases
e. Improper garbage/refuse disposal
f. Unsanitary waste disposal
g. Improper drainage system
h. Poor lightning and ventilation
i. Noise pollution
j. Air pollution
H. Unsanitary Food Handling and Preparation
I. Unhealthy Lifestyle and Personal
Habits/Practices. Specify.
a. Alcohol drinking
b. Cigarette/tobacco smoking
c. Walking barefooted or inadequate
footwear
d. Eating raw meat or fish
e. Poor personal hygiene
f. Self medication/substance abuse
g. Sexual promiscuity
 h. Engaging in dangerous sports E. Abortion
i. Inadequate rest or sleep F. Entrance at school
j. Lack of /inadequate G. Adolescence
exercise/physical activity H. Divorce or separation
k. Lack of/relaxation activities I. Menopause
l. Non use of self-protection measures J. Loss of job
(e.g. non use of bed nets in malaria K. Hospitalization of a family member
and filariasis endemic areas). L. Death of a member
J. Inherent Personal Characteristics-e.g. poor M. Resettlement in a new community
impulse control N. Illegitimacy
K. Health History, which may O. Others, specify.___________
Participate/Induce the Occurrence of Health
Deficit, e.g. previous history of difficult labor. PROBLEM PRIORITIZATION
L. Inappropriate Role Assumption- e.g. child
assuming mother’s role, father not
Nature of the problem 1 = constant
assuming his role.
M. Lack of Immunization/Inadequate ❖ Health deficit 3
Immunization Status Specially of Children
N. Family Disunity-e.g. ❖ Health threat 2
a. Self-oriented behavior of member(s) ❖ Foreseeable 1
b. Unresolved conflicts of member(s) crisis
c. Intolerable disagreement
O. O. Others. Specify._________ Modifiability of the 2 = constant
problem
III. Presence of health deficits / instances of failure ❖ Easily 2
in health maintenance. modifiable

A. Illness states, regardless of whether it is ❖ Partially 1

diagnosed or undiagnosed by medical modifiable
practitioner.
❖ Not modifiable 0
B. Failure to thrive/develop according to
normal rate Preventive Potential 1 = constant
C. Disability - whether congenital or arising
from illness; transient/temporary (e.g. ❖ High 3
aphasia or temporary paralysis after a CVA) ❖ Moderate 2
or permanent (e.g. leg amputation
secondary to diabetes, blindness from ❖ Low 1
measles, lameness from polio)
Salience 1 = constant
IV. Presence of stress points / foreseeable crisis ❖ High 2
situations
● anticipated periods of unusual demand on ❖ Moderate 1
the individual or family in terms of
❖ Low 0
adjustment/family resources.

A. Marriage
B. Pregnancy, labor, puerperium
C. Parenthood
D. Additional member-e.g. newborn, lodger
Second Level of 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:
a. Social-stigma, loss of respect of
peer/significant others
b. Economic/cost implications
c. Physical consequences
d. 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. 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:
a. Absence of responsible member
b. Financial constraints
c. 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.
 a. Role denials or ambivalence
b. Role strain
c. Role dissatisfaction
d. Role conflict
e. Role confusion
f. Role overload
g. Others. Specify. ___
IV. Inability to provide a home environment
conducive to health maintenance and personal
development due to:
A. Inadequate family resources specifically:
a. Financial constraints/limited financial
resources
b. 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. _________
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 :
a. Physical/psychological
consequences
b. Financial consequences
c. Social consequences
F. Unavailability of required care/services
G. Inaccessibility of required services due to:
a. Cost constraints
b. Physical inaccessibility
H. Lack of or inadequate family resources,
specifically
a. Manpower resources, e.g. baby
sitter
b. 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
K. care
L. Others, specify __________
Assessment
- measuring status of the family
- ability to maintain itself
- ability to maintain wellness
- prevent, control and resolve problems
- data are compared with the norms and
standards
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. Family Health Assessment
1. 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 matter of
health care
6. General family relationship/dynamics –
presence of any obvious/readily
observable conflict between members;
characteristics,
communication/interaction patterns
among members
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
Home and Environment
- Information on 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 (e.g. 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
2. Kind of Neighborhood, e.g. congested, slum
etc.
3. Social and health facilities available
4. Communication and transportation facilities
available
Health Status of Each Family Members
1. Medical nursing history indicating current or
past significant illnesses or beliefs and
practices conductive 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 = wight 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 cm in women)
Dietary History specifying quality and quantity of
food or nutrient 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 lifestyles diseases
e.g. hypertension, physical inactivity, sedentary
lifestyle, cigarette/tobacco smoking, elevated blood
lipids/cholesterol, obesity, diabetes mellitus,
inadequate fiber intake, stress, alcohol, 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