`ANGELES UNIVERSITY FOUNDATION

Angeles City

COLLEGE OF NURSING

FORMAT OF A FAMILY CASE ANALYSIS

I. INTRODUCTION
A. Objectives
a. Student-Centered
i. Short-term
ii. Long-term
b. Family-Centered
i. Short-term
ii. Long-term

B. Entry, Climate of acceptance and first few words

II. FAMILY CONSTELLATION

Ag Position in the Educational Present Health

Name Gender
e Family Status Status

III. HEALTH ASSESSMENT (IPPA-CEPHALOCAUDAL) – INITIAL ASSESSMENT

a. Start from the head of the family
b. Mother’s obstetrical history (past to present)
c. Growth and Development (below six years old)
- Erik Erikson’s Psychosocial Stages
- Sigmund Freud’s Psychosexual Stages
d. Immunization Status (below 12 months – if any)
e. Nutrition Status by age, weight and height
f. History of Past and Present Illness (if any) / chronologically arranged
g. Activities of daily living
- Sleeping pattern
- Eating pattern
- Leisure time activities

IV. SOCIO ECONOMIC, CULTURAL AND ENVIRONMENTAL ASSESSMENT

a. Type of family
b. Dominant family member(s) in terms of decision-making especially to health care
c. Source of income, expenditures
- Adequacy to meet basic needs
- Any financial assets available in case of emergency
d. Working hours
e. Ethnic background and religious affiliation
f. Significant other’s role(s) in the family life
g. Health habits/beliefs
h. Family’s involvement in community activities
i. Family’s utilization of community resources
 j. Housing condition (type of building, adequacy of living space, sleeping
arrangement, adequacy of furniture, presence of insects/rodents, accident
hazards)
k. Food sources, storage and cooking facilities
l. Water supply (source, ownership, storage)
m. Toilet facility (type, sanitary condition)
n. Drainage system (type, sanitary, condition)
o. Social and health facilities available
p. Communication and transportation facilities

V. PROBLEM IDENTIFICATION

A. List of Problems Identified (prioritized)

B. Priority Setting

PROBLEM #

COMPUTATIO
CRITERIA SCORE JUSTIFICATION
N
Nature of the Problem
- Wellness State
- Health Deficit
- Health Threat
- Foreseeable Crisis

Modifiability of the Problem

- Easily modifiable
- Partially Modifiable
- Not Modifiable

Current knowledge, technology and intervention

Family Resources
Resources of the Nurse
Community Resources

Preventive Potential
- High
- Moderate
- Low

Gravity/severity of the problem

Duration of the problem
Current management
Exposure of high risk groups

Salience
-A condition or a problem, needing immediate
attention
-A condition or a problem not needing immediate
attention
-Not perceived as a problem or condition needing
change

TOTAL SCORE:
VI. FAMILY NURSING CARE PLAN (in order of priority)

First Level Assessment Problem#

TITLE:

NURSING SUPPORTING DATE GOALS AND Intervention plans Evaluation

PROBLEMS DATA CUES IDENTIFIED: OBJECTIVES
(2ND Level DATE
Assessment) RESOLVED:

Nursing Method Standards Methods

Interventions and and Tools
Resources

VII. FAMILY COPING INDEX

INITIAL FINAL
CATEGORY JUSTIFICATION
1 3 5 1 3 5

● There are nine categories under
this part:
● PHYSICAL INDEPENDENCE
● THERAPEUTIC COMPETENCE
● KNOWLEDGE OF HEALTH
CONDITION
● APPLICATION OF PRINCIPLES OF
GENERAL AND PERSONAL
HYGIENE
● HEALTH CARE ATTITUDES
● EMOTIONAL COMPETENCE
● FAMILY LIVING PATTERNS
● PHYSICAL ENVIRONMENT
● USE OF COMMUNITY FACILITIES
● Use a legend to ● Justify as to why you
mark the score have said that the
you assigned for family’s competence is
each category. as such for the initial
● For e.g., and final home visit.
● For e.g.,
Initial:
_____________________
_____________________
_____________________
_____________________
_____________________

Final:
● In this column, you may include the _____________________
description of the category. For _____________________
e.g., _____________________
_____________________
PHYSICAL INDEPENDENCE ___________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________
___________________________________

VIII. LEARNING DERIVED

IX. SOCIOGRAM
 (With day-to-day objectives and detailed account of what has transpired during the day, e.g.
implementations, accomplishments for the day, etc; you may Include pictures of before and
after for the FCA if applicable)

X. SPOT MAP and DOCUMENTATION