FAMILY COPING INDEX

Prepared by:
NISHA CHAND
MN 1st Year
Maharajgunj Nursing Campus
Family Coping Index
• Family coping index is a tool used to assess the coping ability of the
family for certain health situation with its purpose of providing a basis
for estimating the nursing needs of a particular family
• A nursing need is present when:
- The family has a health problem with which they are unable to
cope.
- There is reasonable likelihood that nursing will make a
difference in the family’s ability to cope.
• Effective coping is the ability to perform certain health tasks.
Contd………………

• Family Coping Index (Modified from Dizon, 1997) is designed to

record family rather than individual coping capacity.

• It has been selected as an index of nursing need because the particular

contribution of nursing to health care is to strengthen or supplement
the capacity of the individual or family as it encounters the stress of
illness or the opportunity to prevent disease and to promote health.
 Features

• Nursing needs can be defined in terms that is in relation to the nursing

intervention that is required.

• Nursing needs must be based on nursing itself.

• The health problem, the attitude and knowledge of the family, the
availability to medical and hospital resources will determine in some
measure the mix of nursing skills required by a particular time but
regardless of the type of problem, the area and the extent of nursing need.
 Contd…………
Coping
• Defined as dealing with problems associated with care with reasonable success
Coping deficit
• When the family is unable to cope with one and other aspect of health care
To Cope
• Ability or capacity to deal with health situation; the control with the health
competence of the family
Direction for Scaling
• The coping index consist of two parts:
1. A point on the scale
2. A justification statement
• This scale enables the community health nurse to place the family in
relation to their ability to cope with the nine areas of family nursing at
the time observed as expected to in 3 month or at the time of discharge
if nursing care were provided.
 Contd……………..
• Coping capacity is rated from 1 (totally unable to manage this aspect of
family care) to 5 (able to handle this aspect of care without help form
community resources) .
• Indicate no problem if the particular category is not relevant to the
situation.
• When each of the nine categories has been rated, the result will be a
profile of family coping capacity in relation to the family nursing
required and changes the community health nurse expect to occur in the
course of nursing service.
 Direction for scaling
• The justification consist of brief statement or phrases which explains why
the community health nurse have rated the family.
• These statements should be expresses in terms of behavior or observable
facts.
• The significance of those statements is crucial as he try to explain how
the family has changed.
• The evaluation should be repeated at three months interval if the family is
supervised for a long period of time, whenever there is a drastic change
in the situation.
General considerations

• It is the coping capacity and not the underlying problem that is

being rated.

• It is the family and not the individual that is being rated.

• Rating should be done after 2-3 home visits when the nurse is
more acquainted with the family.
Cont………

The scale is as follows:

▪ 0-2 or no competence

▪ 3-5 coping in some fashion but poorly

▪ 6-8 moderately competent

▪ 9 fairly competent
Cont……….
Justifications should be expressed in terms of behavior or
observable facts.
Terminal rating is done at the end of the given period of time.
This enables the nurse to see the progress the family has made in
their competence; whether the prognosis was reasonable; and
whether the family needs further nursing service and where
emphasis should be placed.
Nine Areas of Family Nursing Family Coping Index:
1. Physical Competence
2. Therapeutic Competence
3. Knowledge of Health Condition
4. Application of Principle of General Hygiene
5. Health Attitudes
6. Emotional Competence
7. Family Living
8. Physical Environment
9. Use of Community Facilities
1. Physical Competence

• It is concerned with ability to move about, to get out of bed, to take

care of daily grooming, walking, etc.

• Note that it is the family competence that is measured even though an

individual is dependent, if the family is able to compensate for this,
the family may be independent.
Physical Competence………
• Quality and quantity of care is important if the focus of care is poor
• If a mother is giving care to a handicapped child that she could give
herself
• If a person is giving care that should be shared with other members
• The independence might be considered incomplete.
 Contd……………
• The causes of dependence may vary and may be due to:
- actual physical incapacity
- the inability of “know-how” to unwillingness; or
- fear of doing the necessary tasks
• Family failing entirely to provide required personal care to one or more of
its members.
• Examples: • Arthritic patient unable to get out of bed alone, no one
available to help
• patient “cannot” give his hypodermic medication because of fear
 Contd………………
• Family providing partially for needs of its members, or providing care for
some members but not for others.
Examples
• Mother may be doing well with own and husband’s care but failing to give
daily care efficiently to a newborn baby
• Daughter may be giving excellent physical care to aged mother but at cost
of neglecting children somewhat, or with poor mechanics that place undue
strain upon her.
Contd……………….
• All family members, whether or not there is infirmity or disability in
one or more of its members
• receiving the necessary care to maintain cleanliness, including skin
care
• able to get about as far as possible within their physical abilities
• receiving assistance when needed without interruption or undue delay
1. Family failing entirely to provide personal care to its members: - No
Independence.
2. Family providing partially the needs of its members or proving care
for some members but not for others: - Incomplete Independence.
3. All family members receiving necessary care to maintain health and
personal hygiene: - Complete Independence
2. Therapeutic Competence
• Includes all of the procedures or treatments prescribed for the care of
illness, such as giving medications, using appliances (including
crutches), dressings, exercises and relaxation, special diets, etc.
• Family either not carrying out procedure prescribed or doing it
unsafely.
• Giving several medications without being able to distinguish one from
the other, or taking them inappropriately, applying braces so they
throw the limb out of line, measuring insulin incorrectly;
• Family resents, rejects, or refuses to give necessary care.
Contd………….
• Family carrying out some but not all of the treatments
• giving insulin but not adhering strictly to diet
• carrying out procedure awkwardly, ineffectively, or with resentment
or necessary anxiety
• may be giving medication correctly, but not understanding purposes
of the drug, or symptom to be observed
• Family able to demonstrate that the members can carry out the
prescribed procedures safely and efficiently, with the understanding of
the principles involved and with a confident and willing attitude.
1. Family either not carrying out procedures prescribed or doing it
unsafe: - No competence.
2. Family carrying out some but not all of the treatments: -
Moderately Competence.
3. Family able to demonstrate that they can carryout the prescribed
procedures safely and efficiently: - Complete Competence.
3. Knowledge of Health Condition
• Concerned with the particular health condition that is the occasion for
care.
• Knowledge of the disease or inability to understand communicability
of disease and modes of transmission
• Understanding of general pattern of development of a newborn baby,
and the basic needs of infants for physical care or tender loving care
Contd……………..
• Totally uninformed or misinformed about the condition.
Examples:
• believes tuberculosis is caused by sin
• believes stroke patient must be bedridden, and that it is cruel to make
them do something for themselves
• overweight in the school-age child
Contd………….
• Has some general knowledge of the disease or condition, but has not
grasped the underlying principles, or is only partially informed.
• may recognize need for tender loving care but not relate this to
placing the baby’s crib near people when he s awake; or holding him
when feeding
• may accept fact that patient is dying but not see need to prepare
family for this event
• may understand dietary and insulin control of diabetes, but not need
for special care of feet, etc.
Contd…………..

• Knows the salient facts about the disease well enough to take
necessary action at the proper time, understands the rationale of care,
able to observe and report significant symptoms.
1. Totally uninformed about the condition or misinformed: -
unsatisfactory knowledge.
2. Has some knowledge of the disease or condition but has not
grasped the underlying principles: - Satisfactory Knowledge.
3. Knows the salient facts about the disease well enough to take
necessary action at proper time: - Good Knowledge.
4. Application of Principles of General Hygiene
• Concerned with family action in relation to maintaining family
nutrition, securing adequate rest and relaxation for family members,
carrying out accepted preventive measures such as
• Immunizations
• medical appraisal
• safe homemaking habits in relation to
Contd………………
• Family diet grossly inadequate or unbalanced, necessary immunization
not secured for children
• house dirty, food handled in unsanitary way
• members of family working beyond reasonable limits
• children and adults getting too little sleep
• family members unkempt, filthy,
• inadequately clothed in relation to weather
Contd………………...
• Failing to apply some general principles of hygiene—for instance,
• keeping house in excellent condition but expending too much energy
and becoming over fatigue as a result
• secured initial immunization
• general riot and homemaking skills good, but father carrying two full-
time jobs
• Household runs smoothly, family meals well selected; habits of sleep
and rest adequate to needs.
1. Family diet grossly inadequate or unbalanced, necessary
immunizations not secured for children, house dirty, food handled
in an unsanitary way: - No Application.
2. Failing to apply some general principle of hygiene for instance
secure initial immunizations but not boosters or some but not all
available immunization: - Moderate Application.
3. Household runs smoothly, family meals well selected, habits to
sleep and rest adequate to needs: -Complete Application.
5.Health Attitudes
• Concerned with the way the family feels about health care in general,
including preventive service, care of illness and public health
measures.
• Family resents and resist all health care
• Has no confidence in doctors
• Uses patent medicines and quack nostrums
• Feels illness is unavoidable and to be borne rather than treated
• Feels community health agencies should not interfere or bother them
• Practice folk medicine or superstitious rites of illness
Contd……………..
• Accepts health care in some degree, but with reservations
• may accept need for medical care for illness, but not general
preventive measure
• may have confidence in doctors generally, but not in the clinic or in
“free” doctors
• may feel certain illnesses are hopeless (such as cancer), or care
unnecessary—for instance dental care for the young child
Contd…………….
• Understands and recognizes need for medical care in illness and for
the usual preventive services
• arranges for periodic physical appraisals and follows through with
recommendations
• accepts illness calmly and recognizes the limits it imposes while
doing all possible to effect recovery and rehabilitation
1. Family resents and resists all health care, has no confidence in
doctors uses patent medicines: - Unsatisfactory Attitude
2. Accepts health care to some degree, but with reservations. Ex: -
Accept need for medical care for illness but not preventive
measures: - Satisfactory Attitude.
3. Understands and recognizes need for medical care in illness and for
usual preventive services: - Good Attitude.
 6.Emotional Competence
• This category has to go with the maturity and integrity with which the
members of the family are to meet the usual stresses and problems of life,
and to plan for happy and fruitful living.
• The degree to which individuals accept the necessary disciplines imposed
by one’s family and culture
• the development and maintenance of individual responsibility and decision
• Willingness to meet responsibility and decision
• Willingness to meet reasonable obligations, to accept adversity with
fortitude, to consider the needs of others as well as one’s own
Contd……………..
• Family does not face realities
• Assumes moribund patient will get well, that an unwanted pregnancy
isn’t so
• One or more member lacking in any emotional control—uncontrollable
rages
• Irresponsible sexual activities
• One or more members are alcoholic
• Family torn, suspicious of one another
• Evidence of great insecurity, guilt or anxiety
Contd…………
• Family members usually do fairly well, but one or more members
evidence lack of security or maturity.
• Thumb sucking in late childhood
• Unusual concern with what the neighbors will think
• Failure to plan ahead for foreseeable emergencies
• Leaving children unattended
• “Fighting” in the family on occasion
Contd………………
• All members of the family able to maintain a reasonable degree of
emotional clam, face up to illness realistically and hopefully
• Able to discuss problems and difference with objectivity and
reasonable emotional control
• Do not worry unduly about trivial matters
• Consider the needs and wishes of other family members, of neighbor
and those with whom they work and live in making decisions upon
action
1. Family does not face realities, assume moribund patient will get
well: - No Competence.
2. Family members usually do fairly well but one or more members
evidences lack of security or maturity: -Moderate Competence.
3. All members of the family able to maintain a reasonable degree of
emotional calm, face upto illness realistically and hopefully: -
Complete Competence.
 7. Family Living

• This category is concerned largely with the interpersonal or group aspects of

family life
• How well the members of the family get along with one another
• The ways in which they make decisions affecting the family as a whole
• The degree to which they support one another and do the things as a family
• The degree of respect and affection they show for one another
• The ways in which they manage the family budget
• The kind of discipline that prevails
Contd…………….
• Family consists of a group of individuals indifferent or hostile to one
another, so strongly dominated and controlled by a single family
member
• No control of children or family to totally dependent on one another
that they are being stifled
 mother developing habits of dependence in sons thereby threatening
future capacity for independence in own family life
 no rational plan for managing available money
 “battered” child.
Contd……………
• Family gets along but has habits or customs that interfered with the
unity of the family.
• A family fond of one another have many home activities, but is
dominated by a father in a kindly way
• Recreational habits separated members of the family much of the time
• Children somewhat overprotected
• Parents’ expectations on their children are sometimes unrealistic—
parents expecting children with low academic competence to become
successful professionals.
Contd…………
• Family does things together, each member acts for the good of the
family as a whole
 children respect parents and vice-versa
 family tasks shared, evidence of planning
1. Family consists of a group of individuals indifferent or hostile to one
another or strongly dominated and controlled by a single-family
member, no control of children: - Unsatisfactory
2. Family gets along but has habits or customs that interfere with their
effectiveness or coherence as a family: -Satisfactory.
3. Family cohesive does things together each members acts for the
good of the family as whole children respect parents and vice versa:
- Good
8. Physical Environment
• This topic is concerned with the home, the community and the work
environment as it affects family health.
• The condition of the house such as the
 presence of accident hazards, screening, plumbing system, facilities
for cooking and privacy
 level of community (deteriorated neighborhood, presence of social
hazards such as rats), transportation, condition of schools, and
Contd…………..
• House in poor condition—unsafe, unscreened, poorly ventilated
• Neighborhood deteriorated— juvenile and adult delinquency, no
recreational space except streets
• House needs some repair or painting but fundamentally sound
• Neighborhood with some undesirable social elements but possible to
protect children from poor social influence through education and
other community activities
• House crowded but adjustments can be made
Contd………………
• House in good repair
• Provides for privacy and is free of accidents and pest hazards
• Neighborhood respectable and provided with recreational facilities for
children
• Free from undesirable social elements
• Opportunities for community
1. House in poor condition, unsafe, unscreened, poorly ventilated
neighborhood deteriorated, no playing space except streets: -
Unsatisfactory environment.
2. House need some repair or painting but fundamentally sounds: -
Satisfactory environment.
3. House in good repair, provides for privacy for members and is free
of accident and best hazards: - Good environment.
9.Use of Community Facilities
• This category has to do with the degree of the family use and
awareness of the available community facilities for health education
and welfare.
• This includes the ways in which they would use services of private
physicians, clinics, hospitals, schools, welfare organizations, churches,
and so forth.
• The coping ability does not indicate the level of the need for services,
but rather the degree to which they
 Contd……………….
• Family has obvious and serious social needs, but has not sought or found
any help.
A family may be borrowing unreasonable sums of money for medical care,
instead of availing of the free hospitals or clinics
Leaving children without any supervision while the mother works
Failing to take steps to register for public housing when available
 Using resources inappropriately, for example, calling ambulance or using
emergency services for minor injuries
 Contd……………..
• Family is aware of and uses some, but not all of the available
community resources that they need.
• The family may be under welfare care, and seeks the assistance of the
social worker responsible.
• But on the other hand, overlooks the help that could be extended them
by the school counselors or the spiritual guidance the church can
provide.
contd………….
• Uses the facilities they need appropriately and promptly.
• Knows when and whom to call for help.
• Feels secure in their relationship with community workers such as
social workers, teachers, doctors, etc.
1. Family has obvious and serious social needs, but has not sought or
found any help for them: - No usage
2. Family knows about or uses some but not all of the available
community resources that they need: - moderate usage
3. Family using the facilities they need appropriately and promptly
know when and whom to call for help: - complete usage