Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 11

Materials:
LESSON TITLE: Family Health Assessment Pen, paper, index card, book, and class List

LEARNING OUTCOMES:
Reference:
At the end of the lesson, the nursing student can:
1. Discuss family health assessment; Famorca, Z. U., Nies, M. A., & McEwen, M. (2013).
2. Outline the steps in family health assessment; and, Nursing Care of the Community. Elsevier
3. Discuss the data gathering methods and tools. Gezondheidszorg.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the four types of family that can be usually observed in the Philippines? Explain each briefly.
1. ______________, ___________________________________________________________________________
2. ______________, ___________________________________________________________________________
3. ______________, ___________________________________________________________________________
4. ______________, ___________________________________________________________________________

MAIN LESSON (30 minutes)

Family Health Assessment

In the family health nursing, this involves a set of actions by which the nurse measures the status of the family as a client, its
ability to maintain itself as a system and functioning unit, and its ability to maintain wellness, prevent, control and resolve
problems in order to achieve health and well-being among its members.

Data about the present condition or status of the family are compared against norms or standards of personal, social and
environmental health, system integrity and ability to resolve system problems.

These norms or standards are arrived from values, beliefs, principles, rules or expectation.

Nursing Assessment includes data collection, data analysis or interpretation and problem definition or nursing diagnosis.

These are:
1. First level assessment is a process whereby existing and potential health conditions or problems are categorized as:
a. Wellness state
b. Health threats
c. Health deficit
d. Stress points or foreseeable crisis situation
2. Second level assessment defines the nature or type of nursing problems that the family encounters in performing the
health tasks with respect to a given health condition or problems and etiology or barriers to the family’s assumption of
these task.

Steps in family Nursing Assessment

There are three major steps in nursing assessment as applied to family nursing practice.

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Education (Department of Nursing) 1 of 6
Data collection for first level assessment involves gathering of five types of data which will generate the categories of
health conditions or problems of the family. These data include:
1. Family structure, characteristics and dynamic-include the composition, demographic data of the members of the
family/household, their relationship to the head and place of residence, the type of, and family interaction /communication
and decision-making patterns and dynamics
2. Socio-economic and cultural characteristic-include occupation, place of work and income of each working member;
educational attainment of each family member; ethnic background and religious affiliation; significant others and the role
they play in the family’s life; the relationship of the family to the larger community
3. Home environment included information on housing and sanitation facilities; kind of neighborhood and availability of
social, health; communication and transportation facilities in the community
4. Health status of each member includes current and past significant illness; beliefs and practices conducive to health
and illness; nutritional and development status; physical assessment findings and significant results of
laboratory/diagnostics/screening procedures
5. Values and practices on health promotion/maintenance and disease prevention include use of preventive services;
adequacy of rest/sleep, exercise. Relaxation activities, stress management of other healthy lifestyle activities, and
immunization status of at-risk family members.

Second-level assessment data include:

1. Specify or describe the family’s realities
2. Perceptions about and attitudes
3. Performance of health task on each health condition or problem identified during the first level assessment

Data Gathering Methods and Tools

 There are several methods of data gathering that the nurse can select from depending on the availability of resources such
as materials, manpower, time and facilities.
 The critical point in the choice is concern for validity, reliability and adequacy of assessment data.
 Poor quality /inaccurate and inadequate data can lead to inaccurately defined health and nursing problems which, in turn,
lead to a poorly designed family nursing care plan.

The following are brief description of common methods of gathering data about a family, its status and state of functioning;
1. Observation- this method of data collection is done through the use of the sensory capacities- sight, hearing, smell
and touch. Through direct observation the nurse gathers information about family’s state of being and behavioral
responses. The family’s health status can be inferred from the signs and symptoms of the problem areas reflected in the
followings:
a. Communication and interactions pattern expected, used and tolerated by family members
b. Role perceptions/task assumptions by each member, including decision-making patterns
c. Conditions in the home and environment
2. Physical Examination- significant data about health status of individual family members can be obtained through direct
examination. This is done through inspection, palpation, percussion, auscultation, measurement of specific body parts and
reviewing the body system. It is essential for the nurse to have the skills in performing physical assessment / appraisal in
order to help the family be aware of the health status of its member.
3. Interview – another major method of data gathering is the interview.
a. One type of interview is completing a health history for each family member.
b. Second type interview is collecting data by personally asking significant family members or relatives questions
regarding health, family life experiences and home environment to generate data on what wellness condition and
health problems exist in the family (first level and second level of assessment)
Notes:
 Productivity of the interview process depends upon the use of effective communication techniques to elicit the needed
responses.
 One major problem encountered by practitioners in gathering data (especially for the second level assessment) is how
to ascertain where the client is in terms of perception of health condition or problems and the patterns of coping
utilized to resolve them.
 Second level of assessment can be adequately done for each wellness state, health threats, health deficit or crisis
situation by going through the following procedures:

a. Determine if the family recognizes the Sample interview:

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Education (Department of Nursing) 2 of 6

existence of the condition or problem.
If the family does not recognize the
presence of the condition or problems,
explore the reasons why.
b. If the family recognizes the presence of
the condition or problem, determine if
something has been done to maintain
the wellness state or resolve the
problem. If the family has not done
anything about it, determine the
reasons why.if the family has done
something about the problem or
condition, determine if the solution is
effective.
c. Determine if the family encounters other
problems in implementing the
interventions for the wellness state
/potentials, health threats, health deficit
or crisis. What are these problems?
d. Determine how all the other members are
affected by the wellness
state/potentials, health threats, health
deficit or crisis.
1. What do you think about the condition pf your…...?
(Ano and palagay ninyo sa kalgayan ng inyong ……...?)
2. What do you think is the reason why he appears……
(e.g., lethargic, thin) or, why do you think he is behaving
this way…...?) (Ano s apalagay ninyo and dahilan kung
bakit siya nagkaganyan?)
3. What do you think is happening to your……? (Ano
sa palagay ninyo ang nangayari sa inyoong……?)
Sample interview:
1. What have you done to improve the condition or situation?
(Ano na ang nagawa ninyo para mabago and
kalagayan ……or mapaigi and pakiramdam…...?)
2. What are your plans regarding this? (Ano ang
inyong mga binabalak tungkol dito?)
3. What improvements in the condition of…… have
been observed? (Anong mga pagbabago and inyong
napansin sa kalagayan ni…...?)
1. What were the problems or barriers encountered
in…….? (ano-ano and inyong problema sa pagtutupad
nang mga solusyon sa…...? or Anu-ano and mga
nagging sagabal or balakid nang inyong
ginawaang…….?)
2. What do you think are the reasons why there is no
improvement in the condition of …...? Anu-ano sa
palagay ninyo and dahlia kung bakit walang pagbabago
ang kalagayan ni……?)
3. Why did you stop doing what you used do
regarding……? (Bakit ninyo itinigil or hindi ipinagpatuloy
and dating ninyong ginagawa sa…...?)
4. Why did you not cpntinue doing what we have
discussed regarding…...? (Bakit hindi ninyo
ipinagpatuloy and ating pinag-usapan tungkol sa…...?)
5. How did you do it? (Papaano ninyo ginawa ito? or
how often did you do it? (Gaano ninyo kadalasan
ginawa ito??
1. How are the other members affected by………?
(Ano and nagging epekto ng…… sa ibang miyembro
ng pamilya?
2. How are the other members reacting to……...?
(Ano and nagging reaksyon ng ibang miyembro ng
pamilya
sa………?)

4. Record Review- the nurse may gather information through reviewing existing records and reports pertinent to the
client. These include the individual clinical records of the family members, laboratory and diagnostic reports, immunization
records, report about home and environmental conditions or similar sources.
5. Laboratory /Diagnostic Test- another method of data collection is through performing laboratory tests, diagnostic
procedures or other tests of integrity and function carried out by the nurse herself and /or other health workers.

Data Analysis
 Utilizing the data generated from the tool on initial base in family nursing practice, the nurse goes through data analysis. She
sorts out and classify or group data by type or nature (e.g., which are wellness states, threats, deficits or stress
points/foreseeable crisis. She relates them with each other and determines patterns or reoccurring themes among data.
She then compares these data and the patterns or reoccurring themes with norms or standards.

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Data Analysis involves several sub-steps:
 Sorting of data for broad categories such as those related with health status or practices of family members or data about
home and environment
 Clustering of related cues to determine relationships between and among data
 Distinguishing relevant from irrelevant data to decide what information is pertinent to understanding the situation at hand
and what information is immaterial.
 Identifying patterns such as physiologic function, developmental, nutritional /dietary, coping/adaptation or communication
pattern and lifestyle
 Comparing patterns with norms or standards of health, family functioning and assumption of health task
 Interpreting results of comparisons to determine signs, symptoms or cues of specific wellness state, health deficit, health
threats or foreseeable crisis/s/stress point/ and their underlying causes or associated factors
 Making inferences or drawing conclusions about the reasons for the existence of the health condition or problems or
risks for non-maintenance of wellness state which can be attributed to non-performance of family health tasks.

CASELET
You are a nurse assigned to conduct a family health assessment in a Barangay. You visit the Cruz family, which consists of the
parents, Miguel and Ana, and their three elementary-age children. During the assessment, you learn that Miguel is a
construction worker, while Ana is a housewife. The family lives in a modest house, but faces financial challenges.

QUESTION
Discuss the important aspects to consider in conducting a comprehensive family health assessment for the Cruz family.
Address their unique circumstances and identify potential health risks and strategies for promoting their well-being, considering
their specific needs and resources available.

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You
are given 20 minutes for this activity:

Multiple Choice

1. A nurse is preparing to conduct interview survey. Which of the following data should the nurse collect as a component of the
assessment (Select that all Apply:
a. Family structure, characteristics and dynamic
b. Individual who holds power within the community
c. ethnic background and religious affiliation
d. stress management of other healthy lifestyle activities,
ANSWER: ________
RATIO:__________________________________________________________________________________________
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2. A nurse is completing a need assessment and beginning analysis of data. Which of the following actions should the nurse
take first?
a. Determine health patterns within collected data
b. Compile collected data into a database
c. Ensure data collection is complete
d. Identify health needs of the family
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________

3. A nurse is collecting data to identify health needs in the family. Which of the following examples should the nurse identify as
secondary data? Select that all apply. a. Birth statistics

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 b. Previous heath survey
c. Interview survey
d. Community forum
e. Health records
ANSWER: ________
RATIO:__________________________________________________________________________________________
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________________________________________________________________________________________________

4. A nurse is conducting a family assessment. Which of the following data collection methods is the nurse using when having
direct conversation with individual in the family? a. Key informant interview
b. Participant observation
c. Focus group
d. Health survey
ANSWER: ________
RATIO:__________________________________________________________________________________________
_________________________________________________________________________________________________
________________________________________________________________________________________________

5. A nurse is planning a family health program. Which of the following actions should the nurse include as part of the
evaluation plan?
a. Determine availability of resources to initiate the plan
b. Gain approval for the program from the family leaders
c. Establish a timeline for implementation of intervention
d. Compare program impact to similar programs
ANSWER: ________
RATIO:___________________________________________________________________________________________
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________________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________

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Education (Department of Nursing) 5 of 6
 RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track
how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

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AL Activity: Turn and Talk

Instruction: The instructor will pose and prompt a question and you will have to discuss it with for 2 minutes.

Question: As a future professional how can you efficiently conduct family health assessment. Explain.
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