ILOILO DOCTORS’ COLLEGE

College of Nursing
West Ave., Molo. Iloilo City

FAMILY HEALTH NURSING OUTPUT : FAMILY ASSESSMENT W/ FAMILY CARE PLAN

(with RUBRICS)

NAME: _Aldjen N. Setias________________________YR. & SEC._2-K_________ AREA:________________________

CLINICAL INSTRUCTOR: John Paulo Calma__________________________________________________________
Note: Encircle with a red ballpen health problems identified or highlight it. This will be used for skills & RLE outputs.
I INITIAL DATA BASE
A. FAMILY STRUCTURE, CHARACTERISTICS & DYNAMICS/RELATIONAL PATTERN
a.1)
NAME AGE SEX/ CIVIL POSITION IN EDUCATIONAL OCCUPATION RELIGION
(initials only) GENDER STATUS THE FAMILY ATTAINMENT
G. N. 55 M Married Father 1st year High School Brgy. Captain/ Roman
Tricycle driver Catholic
C. N. 46 F Married Mother High School Housewife Roman
Catholic
G. N. 26 M Single Son College Graduate Construction Roman
Worker Catholic
G. N. 25 F Single Daughter College Graduate Housewife Roman
Catholic
G. N. 20 M Single Son First Year College Conductor Roman
Catholic
G. N. 19 M Single Son Grade 11 Student Roman
Catholic
G. N. 16 F Single Daughter Grade 11 Student Roman
Catholic

Note: If their names start with the same letter, write their first names with an initial family name.

a.2) Socio-demographic data of members not currently living in the household but w/ major role in resource
generation and use. (list down family members who are not in the house because of work or some
other reasons but helped in the source of income and needs of the family. State where they are, their
nature of work and the amount they usually send to their family.
 They live in Brgy. Dingle, Miag-ao, Iloilo, near the plaza. They all reside in the same home, except for their
second child who had a son and she temporarily stays in a house close to where they live so that someone can
take care of the house, which is owned by their aunt. Their Father is working asa Brgy. Captain and tricycle
driver earning P6,000 a month. His two eldest and second sons also worked as a construction worker and a
conductor earning P4,000 and P3,600 per month respectively.

a.3) Type of family structure and form and describe it. (simple/nuclear, blended/mixed, matriarchal, patriarchal,
extended, cohabiting, single parent, …etc.)
 Nuclear Family because it is composed of a father and mother with 5 children.

a.4) Dominant family members in terms of decision making (on matters of health care) and care tending. Who
makes the decision for budgeting on food, clothing, education, health, bills and others? Who makes the
final decision?
 The dominant family member in terms of decision-making and care tending is their Mother. Furthermore, both
father and mother make the decisions for budgeting their basic necessities and making the final decision.

a.5) Family dynamics, communication pattern/s, interactional processes & interpersonal relationships which
possess innate or great potential to mediate factors, relevant to health, illness, growth, development
and the family’s ability to handle conflict, change, anticipated & unexpected events. (What are their
roles and functions as family members? How is their relationship with one another? How do they handle
their conflicts or maintain their harmonious/working relationships in the family? What are their
activities together or do they do it individually? How do they handle their tasks when one member gets
sick?
 The father is the breadwinner and chief of the family, while the mother is the manager and treasurer of the
family. The girls help the mother in doing the household chore and the boys are usually assigned the heavy
 work in the house. Their relationship is good, but occasionally arguments and miscommunications between
them are unavoidable. On the other hand, they address their conflicts by trying to stay calm and actively listen
to what their family member is saying and what they mean. When one member of the family gets sick, usually
the mother will cook soup and tends to the sick person, then the father will give money and the children will
buy medicine.

B. SOCIO-ECONOMIC AND CULTURAL CHARACTERISTICS

b.1 Income and Expenses
b.1.1 occupation, place of work & income of each working family member
FAMILY MEMBER OCCUPATION ESTIMATED INCOME
(INITIALS ONLY) (daily/weekly/monthly)
G.N Brgy. Captain & Tricycle driver P6,000
G.N Construction Worker P4,000
G.N E-bus Conductor P3,600
P

b.1.2 adequacy to meet basic necessities. (What is their budget/how much is their budget for each?)

FOOD CLOTHING ELECTRICITY WATER HEALTH EDUCATION TRANSPORTATION

P1,250 P500 P750 P375 P375 P1,500 P100
OTHERS
P P P P P P

b.1.3 who makes decisions about money and how it is spent?

 Both the father and mother make the decision on how much money to spend and they work together to
budget their expenses.

b.2 Educational attainment (reasons why a family member was not able to finish schooling or stopped schooling.
 G.N. Father – Highschool 1st year
Was not able to finish schooling due to financial problems and work at a young age.
 C.N. Mother – High school
Was not able to finish schooling due to financial problems
 G.N. – College Graduate
 G.N. – College Graduate
 G.N. – 1st year College
 G.N. – Senior High School
 G.N. – Senior High School

b.3 Ethnic background & religious affiliation. (Where/what is the origin of the parents? How does the family participate
in their religious activities?)
 The father is from Iloilo and the mother is from Antique

b.4 Family traditions, beliefs, events or practices affecting family health & functioning.
 Attending their private doctor for check-ups. They also go to “Manug-hilot” if they have common colds or
coughs.

b.5 Significant others-roles they play in family’s life. (any support system in any means?)
 None

b.6 Relationship of the family to the community (What is their extent of participation in community organizations &
activities? How is their relationships with their neighbors, relatives and community people?)
 Since the father is a Brgy. Captain, they have participated in various community organizations and activities
such as clean and green drives, community service projects, etc. So they have a good relationships in their
community because they are easy to get along with and always there in times of need.

C. HOME AND ENVIRONMENT

c.1 housing (describe each)
c.1.1 adequacy of living space (estimated area measurement, how many rooms?)
 The estimated area measurement is about 50 sq. with 2 bedrooms, C.R., kitchen, living room, and has closed
balcony.

c.1.2 sleeping arrangement

 The father, the mother, and the youngest daughter sleep in the same bedroom while the other two sons sleep
in the next room and the eldest son sleeps on the balcony.

c.1.3 presence of breeding places or resting sites of vectors/carriers of diseases

 Water storage tanks/ containers in the toilets, bathrooms, and kitchens. They also have poor waste disposal .
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c.1.4 presence of accident and fire hazards
 None

c.1.5 food storage and cooking facilities

 LPG, charcoal, wood, and refrigerator

c.1.6 water supply (source, owned or not owned/community owned, potability & safety)
Drinking: Mineral Water
Washing & Bathing: Hand Pump Well
Cooking: Hand Pump Well

c.1.7 toilet facility (type, ownership, sanitary condition, made of what materials)
 Sanitary toilet: buhos and owned. Made of wood and concrete

c.1.8 garbage/refuse disposal

 Dumping

c.1.9 drainage system (type, sanitary condition)

 Closed

c.2 kind of neighborhood (congested, slum, far apart, clustered houses?)

 Congested

c.3 social and health facilities available

 Barangay Health Center and Private Hospital/Clinic

c.4 communication and transportation facilities

 Cellphones, Tricycle and motorcycle

D. HEALTH STATUS OF EACH FAMILY MEMBER

d.1 Medical and nursing history indicating current or past significant illnesses or beliefs & practices conducive to health
and illness. (pls. include medications taken and their compliance in taking meds.))
 The Father has pneumonia, hence, the Doctor prescribed him antibiotics, and he takes the medicine diligently.

d.2 Nutritional assessment of each member of the family (describe their body size, weight appropriateness to height
and age, dietary history-quantity & quality of food intake, what kind of foods usually taken daily, eating/feeding
habits & practices, developmental assessment of children)
 Their family are healthy with proper nutrition such as vegetables, fruits, meat, fishes, etc.
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d.3 Risk factor assessment indicating presence of major and contributing modifiable risk factors for specific lifestyle
diseases (ex., history of hypertension, sedentary lifestyle, smoking, vices, inadequate intake of food in
quality/quantity, anxiety & stress, history of diabetes mellitus, substance abuse, physical inactivity…etc.)
 Asthma

d.4 Physical assessment indicating presence of illness state/s (diagnosed or undiagnosed by medical practitioners)
 None

d.5 Results of laboratory findings/diagnostic and other screening procedures supportive of assessment findings.
(If it is applicable only)
 Upon his results in chest x-ray and blood test, he was diagnosed with pneumonia.

E. VALUES, HABITS, PRACTICES ON HEALTH PROMOTION, MAINTENANCE & DISEASE PREVENTION (ex. What immunizations
did they receive especially the children?, healthy lifestyle practices?, adequacy of sleep, exercise/activities, use of
protective measures like footwear, mosquito nets, mask, gloves, protective clothing?, relaxation & other stress
management activities, opportunities to enhance self-worth and meaningfulness?, use of promotive & preventive
health services like maternal & child health services and use of healthy life-style related services?) Write in bullet
form please.
 Immunization
a. Tetanus toxoid for pregnant e. Polio
women f. Measles, Mumps and Rubella
b. Hepa B vaccine g. Varicella
c. Diphtheria h. Influenza
d. Tetanus i. Covid vaccine
 They eat healthy foods, drink plenty of water and have enough sleep
 They sometimes exercise such as walking and swimming
 They use protective measures such as footwear, facemask, and mosquito nets.
  When they want to relax, they go to the sea to swim or have a picnic, this is one way for them to bond as a
family.
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II TYPOLOGY OF HEALTH PROBLEMS IN FAMILY NURSING PRACTICE (Pls. base this on your health problems identified or
encircled/highlighted in your initial data base. Relate this to the typology in page 67 of Maglaya’s CHN
Book)/Module Guide. Refer to your notes in FAMILY HEALTH NURSING PROCESS.

FIRST LEVEL OF ASSESSMENT

(Top 3-5 Priority health Problems Only)

A. Presence of Wellness Condition (Potential for enhanced capability or Readiness for enhanced capability)
a.1 Potential for Enhanced Capability
1. Healthy maintenance/health management
2. Parenting

a.2 Readiness for Enhanced Capability

1. Healthy lifestyle
2. Parenting

B. Presence of Health Threat (pls. relate to typology in page 68-69 of Maglaya’s CHN book, 5 th edition)
1. Presence of risk factors of specific diseases (e.g. asthma)
2. Threat of cross infection from communicable disease case
3. Poor Home/Environmental Condition/Sanitation.
C. Presence of Health Deficit (pls. relate to typology in page 69 of Maglaya’s CHN book)
1. Presence of illness state such as Pneumonia
2. N/A
3. N/A

D. Presence of Stress Points/Foresseable Crisis Situations (pls. relate to typology in pages 69-70 of Maglaya’s CHN book)
1. Menopause
2. Hospitalization of a family member

SECOND LEVEL OF ASSESSMENT

(Identify the top 2 priority health problem of the family only and write it on the appropriate 2 nd level of assessment
statements.. Pls. refer the following rationale/reasons of failure to do the expected health tasks
in pages 70-72 of Maglaya’s CHN Book, 5th Edition)/Module Guide

A. Inability to recognize the presence of the condition or problem due to:

A. Lack of or inadequate knowledge
B. Attitude/Philosophy in life, which hinders recognition/acceptance of a problem

B. Inability to make decisions with respect to taking appropriate health action due to:
A. Inability to decide which action to take from among a list of alternatives
B. In accessibility of appropriate resources for care, specifically, cost constraints or economical/financial inaccessibility.

C. Inability to provide adequate nursing care to the sick, disabled, dependent or vulnerable/at risk member of the
family due to:
A. Lack of the necessary facilities, equipment and supplies of care
B. Inadequate family resources of care specifically, financial constraints and limitation of luck/lack of physical
resources

D. Inability to provide a home environment conducive to health maintenance and personal development
due to:
A. Lack of/inadequate knowledge of importance of hygiene and sanitation
B. Lack of knowledge of preventive measures.

E. Failure to utilize community resources for health care due to:

A. Inaccessibility of required services due to cost constraints
B. Unavailability of required care/services
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Note: Justification Column: Guide questions are provided above for the CI to guide how the students
are going to analyze the gravity/severity of the prpblem.
Reference: Please see the scaling computation in prioritizing health problems in Maglaya’s
CHN Book/FHN Module Guide

III-Prioritizing Health Problems (Scaling & Computation)

CRITERIA COMPUTATION SCORE JUSTIFICATION

Specific Problem: ____________
__________________________
Nature of the Problem
(please encircle)
a. Health Threat
b. Health Deficit
c. Foreseeable Crisis or
Stress Point

Modification of the
Problem

Preventive Potential

Salience

TOTAL SCORE

IV -List of Prioritization/Ranking of Health Problems

RANK HEALTH PROBLEM CLASSIFICATION SCORE

1

3
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V- FAMILY COPING INDEX (FCI)
Coping may be defined as dealing with problems associated with health care with reasonable success.
When the family is unable to cope with one or another aspect of health care, it may be said to have a coping
deficit. The coping index is composed of a point on the scale and a justification statement. (Pls. refer to your
handouts on (FCI). /coping capacity is rated from 1(totally unable to manage family care) to 5 (able to handle
care w/o help from community resources). Check no problem if it is not relevant. The justification consists of
statements that explain why you have rated the family as you have explained in observable facts. General
considerations include: 1.) It is the coping capacity and not the underlying problem is being rated. 2.) It is the
family and not the individual that is being rated.

SCALE:
No problem 1 – no competence 3 – moderate competence 5 – complete competence

Instuction: Please check the corresponding scale and justify.(Use your FCI guide)

No
CATEGORIES Problem 1 3 5 JUSTIFICATION

1. Physical
Independence

2. Therapeutic
Competence

3. Knowledge of
Health Condition

4. Application of
Principles of
General Hygiene

5. Health Attitudes
 No
CATEGORIES Problem 1 3 5 JUSTIFICATION

6. Emotional
Competence

7. Family Living

8. Physical
Environment

9. Use of Community
Facilities

VI – FAMILY CARE PLAN (pls see attached format)

VII - REFLECTION/INSIGHTS (pls. use the guide questions)

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