Nursing Assessment in Family Nursing Practice

Nursing Assessment – first major phase of the nursing process.

- 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, its ability to maintain wellness, prevent, control or
resolve problems in order to achieve health and well-being among its
members.

Nursing Assessment includes:

 Data collection
 Data analysis or interpretation
 Problem definition or nursing diagnosis – end result of two major
types of nursing assessment in family health nursing practice.

First Level Assessment

- is a process whereby existing and potential health conditions or
problems of the family are determined.

Category of Health conditions/Problems:

 Wellness state/s
 Health Threats
 Health deficits
 Stress points or foreseeable crisis situations

Second Level Assessment

- the nature or type of nursing problems that the family encounters in
performing the health tasks with respect to a given health condition or
problem, and the etiology or barriers to the family’s assumption of the
tasks.

Steps in Family Nursing Assessment

1.Data Collection – gathering of five types of data which will generate

the categories of health conditions or problems of the family.
a.) family structure, characteristics & dynamics – include the
composition and 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.

b.) socio-economic & cultural characteristics – 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 other role(s) they play in the
family’s life; and, the relationship of the family to the larger community.

c.) home and environment – include information on housing and

sanitation facilities; kind of neighborhood and availability of social,
health, communication and transportation facilities in the community.

d.)health status of each member – includes current and past significant

illness; beliefs and practices conducive to health and illness;
nutritional and developmental status; physical assessment findings
and significant results of laboratory/diagnostic tests/screening
procedures.

e.) values and practices on health promotion/maintenance & disease

prevention – include use of preventive services; adequacy of
rest/sleep, exercise, relaxation activities, stress management or other
healthy lifestyle activities, and immunization status of at-risk family
members.

Data Gathering Methods & Tools

a.) Observation – method of data collection through the use of sensory
capacities --- sight, hearing, smell and touch.
Data gathered through this method have the advantage of
being subjected to validation and reliability testing by other
observers.

b.) Physical Examination – done through inspection, palpation, percussion,

auscultation, measurement of specific body parts and reviewing the
body systems.

c.) Interview – completing the health history of each family member. The
health history determines current health status based on significant
past health history.

The second type of 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.

Productivity of the interview process depends upon the use of

effective communication techniques to elicit the needed responses.
  Second level assessment can be adequately done for each wellness
state, health threat, health deficit or crisis situation by going through
the following procedures:

 Determine if the family recognizes the existence of the

condition or problem. If the family does not recognize the
presence of the condition or problem, explore the reasons
why.

 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.

 Determine if the family encounters other problems in

implementing interventions for the wellness state/potential,
health threat, health deficit or crisis. What are these problems?

 Determine how all the other members are affected by the

wellness state/potential, health threat deficit or stress point.

d.) Record Review – reviewing existing records and reports pertinent to the
client. ( individual clinical records of the family members; laboratory &
diagnostic reports; immunization records; reports about the home &
environmental conditions.

e.) Laboratory/Diagnostic Tests – performing laboratory tests, diagnostic

procedures or other tests of integrity and functions carried out by the
nurse herself and/or other health workers.

2. Data Analysis
- sort data
- cluster/group related date
- distinguish relevant from irrelevant data
- identify patterns
- compare patterns with norms or standards
- interpret results
- make inferences/draw conclusions
3. Nursing Diagnoses: Family Nursing Problems

* A wellness condition is a nursing judgment related with the client’s

capability for wellness.
 A health condition or problem is a situation which interferes with the
promotion and/or maintenance of health and recovery from illness or
injury.
 NURSING DIAGNOSIS in the FAMILY NURSING PRACTICE - the
family’s failure to perform adequately specific health tasks to
enhance the wellness state or manage the health problem.

 TYPOLOGY OF NURSING PROBLEMS IN FAMILY NURSING

PRACTICE – classification system of family nursing problems.

FIRST- LEVEL ASSESSMENT

I. PRESENCE OF WELLNESS CONDITION – stated as Potential or

Readiness

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.

III. PRESENCE OF HEALTH DEFICITS – instances of failure in health

maintenance.

IV. PRESENCE OF STRESS POINTS/FORESEEABLE CRISIS SITUATIONS –

anticipated periods of unusual demand on the individual or family in terms
of adjustment/family resources.

SECOND-LEVEL ASSESSMENT

I. Inability to recognize the presence of the condition or problem.

II. Inability to make decisions with respect to taking appropriate health

action.

III. Inability to provide adequate nursing care to the sick, disabled,

dependent or vulnerable/at-risk member of the family.

IV. Inability to provide a home environment conducive to health

maintenance and personal development.

V. Failure to utilize community resources for health care.

DEVELOPING THE NURSING CARE PLAN

THE FAMILY CARE PLAN – is the blueprint of the care that the nurse
designs to systematically minimize or eliminate the identified health and
family nursing problems through explicitly formulated outcomes of care
( goals and objectives) and deliberately chosen of interventions, resources
and evaluation criteria, standards, methods and tools.

DESIRABLE QUALITIES OF A NURSING CARE PLAN

1. It should be based on clear, explicit definition of the problems. A

good nursing plan is based on a comprehensive analysis of the
problem situation.
2. A good plan is realistic.
3. The nursing care plan is prepared jointly with the family. The nurse
involves the family in determining health needs and problems, in
establishing priorities, in selecting appropriate courses of action,
implementing them and evaluating outcomes.
4. The nursing care plan is most useful in written form.

THE IMPORTANCE OF PLANNING CARE

1. They individualize care to clients.

2. The nursing care plan helps in setting priorities by providing
information about the client as well as the nature of his problems.
3. The nursing care plan promotes systematic communication among
those involved in the health care effort.
4. Continuity of care is facilitated through the use of nursing care
plans. Gaps and duplications in the services provided are minimized,
if not totally eliminated.
5. Nursing care plans, facilitate the coordination of care by making
known to other members of the health team what the nurse is doing.

STEPS IN DEVELOPING A FAMILY NURSING CARE PLAN

1. The prioritized condition/s or problems based on:

- nature of condition or problem
 - modifiability
- preventive potential
- salience
2. The goals and objectives of nursing care.
 Expected Outcomes:
- conditions to be observed to show problem is prevented,
controlled, resolved or eliminated.
- Client response/s or behavior
> Specific, Measurable, Client-centered
Statements/Competencies
3. The plan of interventions.
 Decide on:
- Measures to help family eliminate:
. barriers to performance of health tasks
. underlying cause/s of non-performance of health tasks
- Family-centered alternatives to recognize/detect, monitor,
control or manage health condition or problems
- Determine Methods of Nurse-Family Contact
- Specify Resources Needed

4. The plan for evaluating.

- Criteria/Outcomes Based on Objectives of Care
- Methods/Tools

COMMUNITY DIAGNOSIS

TYPES OF COMMUNITY DIAGNOSIS

1. COMPREHENSIVE COMMUNITY DIAGNOSIS – aims to obtain a

general information about the community.
A. Demographic Variables
B. Socio-Economic and Cultural Variables
C. Health and Illness Patterns
D. Health resources
E. Political/Leadership Patterns

2. PROBLEM-ORIENTED COMMUNITY DIAGNOSIS – type of

assessment that responds to a particular need.
PROCESS OF COMMUNITY DIAGNOSIS:

 Collecting
 Organizing
 Synthesizing
 Analyzing and interpreting health data

STEPS IN CONDUCTING COMMUNITY DIAGNOSIS

1. DETERMINING THE OBJECTIVES – the nurse decides on the depth

and scope of the data she needs to gather.
2. DEFINING THE STUDY POPULATION – the nurse identifies the
population group to be included in the study.
3. DETERMINING THE DATA TO BE COLLECTED – the objectives will
guide the nurse in identifying the specific data she will collect, and
will also decide on the sources of these data.
4. COLLECTING THE DATA – the nurse decides on the specific
methods depending on the type of data to be generated.
5. DEVELOPING THE INSTRUMENT – instruments/tools facilitate the
nurse’s data-gathering activities.
Most common instruments:
- survey questionnaire
- interview guide
- observation checklist

6. ACTUAL DATA GATHERING – the nurse supervises the data

collectors by checking the filled-up instruments in terms of
completeness, accuracy and reliability of the information collected.
7. DATA COLLATION – the nurse is now ready to put together all the
information.
8. DATA PRESENTATION – will depend largely on the type of data
obtained. (descriptive & numerical data)
9. DATA ANALYSIS – aims to establish trends and patterns in terms of
health needs and problems of the community.
10. IDENTIFYING THE COMMUNITY HEALTH NURSING PROBLEMS

 Health status problems – increased or decreased

morbidity, mortality, fertility or reduced capability for wellness.
 Health resources problems – lack of or absence of
manpower, money, materials or institutions necessary to solve
health problems.
 Health-related problems – existence of social, economic,
environmental and political factors that aggravate the illness-
inducing situations in the community.
 11. PRIORITY-SETTING – prioritize which health problems can be
attended to considering the resources available at the moment.

CRITERIA WEIGHT
Nature of the Problem
Health status 3 1
Health resources 2
Health-related 1
Magnitude of the problem 3
75% - 100% affected 4
50% - 74% affected 3
25% - 49% affected 2
<25% affected 1
Modifiability of the problem 4
High 3
Moderate 2
Low 1
Not Modifiable 0
Preventive potential 1
High 3
Moderate 2
Low 1
Social Concern 1
Urgent community concern;
expressed readiness 2
recognized as a problem
but not needing urgent attention 1
not a community concern 0

 Nature of the condition/problem presented – problems classified by

the nurse as health status, health resources or health-related
problems.
 Magnitude of the problem – refers to the severity of the problem
which can be measured in terms of the proportion of the population
affected by the problem.
 Modifiability of the problem – probability of reducing, controlling or
eradicating the problem.
 Preventive potential – probability of controlling or reducing the
effects posed by the problem.
  Social concern – perception of the population or the community as
they are affected by the problem and their readiness to act on the
problem.

WHAT IS PLANNING?

PLANNING – is a process that entails formulation of steps to be undertaken

in the future in order to achieve a desired end.

Concepts of Planning:
. Planning is futuristic.
. Planning is change-oriented.
. Planning is a continuous and dynamic process.
. Planning is flexible.
. Planning is a systematic process.

THE PLANNING CYCLE:

1. Situational Analysis
- gather health data
- tabulate, analyze and interpret data
- identify health problems
- set priority

2. Goal and Objective Setting

- define program goals and objectives
- assign priorities among objectives

3. Strategy/Activity Setting
- Design CHN Program
- Ascertain resources
- Analyze constraints and limitations

5. Evaluation
- determines outcomes
- specify criteria and standards

Initial Database for Family Nursing

Process
A. Family Structure, Characteristics and
Dynamics

Name of the Sex Birthday Age

Civil Status Family
Religion
Member Educational Occupation Relationship
Mark Dexter Busa Attainment
M 05-20-82 27 to the Head of
Ana Marie Busa F 08-27-82 26 the Family
Married R. Catholic
Sean Benedict College
M SSS 2
07-02-06 Head of the
Busa Graduate Employee Family
Married R. Catholic College Student Wife
Graduate
Single R. Catholic Toddler Student Son

The Busa Family is a typical nuclear type of family consists of the

father, Mr. Mark Dexter Busa who is a SSS Employee, Mrs. Ana Marie
Busa, a full time student and Sean Benedict, their 2 year old son.
Mr. and Mrs. Busa doesn’t have a hard time in terms of decision
making because each of them tend to consider each others opinion first
before coming up with the final decision especially regarding health matters.
The family has a healthy communication among its members and have an
interactive relationship with each other, although conflict is present at times
most especially regarding the discipline of the child but the couple made
weekly dates to promote an open relationship with each other.
The father is the head and breadwinner of the family while the
mother together with the housemaid takes care of the household chores and
their son Sean Benedict.
All family members are Roman Catholic. To show their dedication
they never fail to go to church every Sunday to give thanks and praise for all
the blessings God has given them the couple is also an active member of
Couples for Christ.
B. Socio-Economic Status
Monthly Income: P 10,000
Weekly Budget: 2,000

Amount Expenditure
P1000 Foods( Groceries)
P500 Bills: Electricity and water
P250 Transportation (Father)
P250 Savings
TOTAL: P2,000

Majority of the family’s budget is allocated to their food needs.

Second to this is their budget to their billings like electricity and water.
Based from the table above you can observe that they give importance to
their savings. This is for the preparation of their child’s future and for
emergency purposes. When it comes to their clothing you can observe it has
not been indicated above for they seldom spend money in clothing.
Financial difficulties of the family are solved by borrowing money
from friends and relatives, to be returned after the head of the family
received his salary.

C. Home and Environment

The Busa Family’s resides in a good compound with their relatives at
58-B Osmeña Street Ormoc City, their house is owned by them and made of
concrete and wood and has two bedrooms, one bathroom, a kitchen, and a
living room which is just enough or adequate for their living space. Every
member of the family has their own bedrooms. Mr. and Mrs. Busa together
with their 2 year old sean share bedrooms while the housemaid have her own
room. The Laundry area is outside the house and the garbage cans are the
resting sites of vectors of disease such as flies, mosquitoes and roaches
 present in Busa family’s house. Their foods are stored in closed door
cabinets and the refrigerator. The de Leon’s’ water supply comes from
ORWASA. The water coming from ORWASA is used for washing,
cleaning, and bathing and not for drinking purposes. The Busa family buys
distilled water from water refilling stations. The Busa family has their own
bathroom and toilet. Their bathroom is near the kitchen and is kept clean
everyday by Mrs. Busa and sometimes the housemaid. Their garbage is
taken out everyday and collected by garbage trucks everyday. They have
three garbage cans inside the house, one is in the kitchen, the other, is in the
bathroom and lastly, near the bedroom. Their neighborhood is safe and not
congested, there is still room for trees and plants to grow and place to play
and hang-out. They have their own telephone line and every family member
except the child has their own cell phones. They also have a family car and
motorcycle for their transportation facility.

D. Health Status of Each Member

Member Heigh Weigh BMI Medical and

Nutritional
of the t t nursing assessment
househol history
Dietar Eating
d y habits
histor and
y practices
Mark 5’8” 188.1 86/3.132 Typhoid 3x a Meat,
Dexter 6 lbs 9= Fever day fruits and
Busa 23.62 vegetabl
es
Ana 5’1” 120 55/2.42 Asthma , 2x a Meat,
Marie lbs = Gastroenterit day fish,
Busa 22.72 is, UTI, fruits and
Allergies vegetabl
es
Sean 3’3” 29.12 13.24/1.0 Tonsillitis, 4x a Meat,
Benedict lbs 2= UTI, Asthma day Milk,
Busa 12.98 fish,
fruits and
vegetabl
es

Mr. Busa has a history of typhoid fever when he was young, he had
completed his required vaccine and less likely to get sick even with a bad
weather. Mrs. Busa has a history of gastroenteritis due to amoeba
infestation; urinary tract infection, asthma and is allergic to chocolates,
chicken, eggs, eggplant, mangoes, some peanuts, and seafoods except
certain kinds of fishes; she has completed the required vaccines. Sean, their
son has a history of recurrent tonsillitis, he is under medication through
prophylactic therapy, a 3-month long oral vaccine to enhance immunity of
his throat, and he also has maintenance for his asthma. He has not yet
completed his booster vaccines.
A constant intake of vitamins like Fern-C and Centrum is the primary
prevention of the family to fight the most common diseases like colds and
cough.

E. Values, Habits, Practices on Health

Promotion, Maintenance and Disease
Prevention
Member of the Immunization Healthy lifestyle
household status of family Practices
members
Mark Dexter Busa complete Basketball 3x/week

Ana Marie Busa complete Stretching and eating

fruits
Sean Benedict Busa Incomplete (Flu Biking in the plaza
and Hepa-A
booster vaccine)
Adequacy of :
Member Rest/ Exercises/ Use of protective Relaxation and
of the sleep activities measures other stress
household management
activities
Mark 8 1 hour Uses jacket, Rest or watch TV
Dexter hour Helmet, or listen to
Busa s sunglasses Christian music
Ana 6-7 30 Uses slippers in Rest and watch
Marie hour minutes and out the house TV or surf the
Busa s and umbrella internet
when raining, and
handkerchiefs
Sean 10- 3 hours Uses jacket, Rest or eat
Benedict 11 depending umbrella when
Busa hour on raining/under the
s playtime sun, cap and
helmet

Mr. & Mrs. Busa has complete immunizations; their son, Sean has not
yet finished his boosters this year like flu and Hepa-A.
Since Mrs. Busa is a Student Nurse, she has applied all learning in the
courses she has taken like proper handwashing, environmental sanitation,
and therapeutic techniques. She makes sure that Sean has adequate sleep
everyday that is why she lets him sleep during afternoons

Initial Database for Family Nursing Practice

A. Family Structure & Characteristics
1. Members of the household & relationship to the head of the family
2. Demographic data age, sex, civil status, position in the family & etc.

3. Place of residence of each members whether living w/ family or elsewhere

4. Type of family structure (ex. matriarchal or patriarchal, nuclear or extended)
5. Dominant family members in terms of decision-making in matters of health care
6. General family relationship presence of any obvious/ readily observable conflict bet.
members,
characteristic communication patterns among members.
B. Socio-economic & Cultural Factors

1. Income & expenses

a. Occupation, place of work & income of each working member
b. Adequacy to meet basic necessities (food, clothing & shelter)
c. Who makes decisions about the money & how it is spent

2. Educational attainment of each member

3. Ethnics background & religious affiliation
4. Significant others roles they play in the family life
5. Relationship of the members to the large community  what’s the participation of the family in
community activities.
C. Environment Factors

1.Ho u si ng
a. Adequacy of living space
b. Sleeping arrangement
c. Adequacy of furniture
d. Presence of insects & rodents
e. Presence of accidental hazards
f.Food storage & cooking facilities
g. Water supply source, ownership, & potability

h. Toilet facility type, ownership, sanitary condition

i.Garbage/ refuse disposal type, sanitary condition

j.Drainage system type, sanitary condition

2. Kind of neighborhood (ex. congested, slum & etc.)
3. Social & health facilities available
4. Communication & transportation facilities available

D. Health Assessment of Each Member

1. Medical & nursing history indicating past significant illnesses, beliefs & practices conducive to illness
a. Anthropometric data ex. weight, height, mid-upper arm circumference
b. Dietary history indicating quality & quantity of food intake per day
c. Eating/f feeding/ habits/ practices
2. Developmental Assessment of infants, toddlers and preschoolers– e.g. Metro Manila
 Developmental Screening Test (MMDST)
3.Nutritional assessment (especially for vulnerable or at risk members)
4.Physical Assessment /Current health status indicating presence of illness states (diagnosed or
undiagnosed by medical practitioner)
5.Results of laboratory/diagnostic procedures supportive of physical assessment findings

E. Values and Practices on Health Promotion/Maintenance and Disease Prevention

1.Immunization status of children and family members
2.Use of other preventive services
3.Adequacy of:

a. Rest and Slee

b.Exe r ci se
c. Relaxation Activities
d. Stress Management Activities

F. Family Community Diagnosis

Sequence of Activities in Family Nursing Practice

1.Establishment of working relationship with the family

a. initiates contact
b.communicates interest in family’s welfare
c. expresses/ shows willingness to help w/ expressed needs
d.maintains a two-day communication w/ the family

2.Conducts an initial assessment to determine the presence of any health problem

¤ Tool Typology of Nursing Problem in Family Nursing Practice

3.Categories health problems into:

a. health threats
b.health deficits
c. stress points/ foreseeable crisis

¤ Tool Typology of Nursing Problem in Family Nursing Practice

4.Determine the nature & extent of the family’s performance of the health tasks on each
of the health
problems categorized in activity no. 3 : defines the family nursing problems
¤ Tool Typology of Nursing Problem in Family Nursing Practice second level assessment

5.Determine the priorities among the lists of health problems

a. consider the nature of the problems presented
b.evaluates the modifiability of the problem
c. evaluates the preventive potential of a problem
d.evaluates the family’s perception/ evaluation of each problem in the term of seriousness &

urgency of attention needed

¤ Tool Seals for Ranking Family health Problems Accdg. To priorities
6.Decides on what problems to take in the order of immediate, urgency based on priorities set.
7.Ranks health problems according to priorities
8.Defines nursing objectives in realistic measurable terms jointly w/ the family
9.Plans approaches, strategies of action/ intervention, criteria & standards of evaluation
10.Implements the plan of care
11.Evaluates the effectiveness of implemented aspects of the plan
12.Re-defines nursing problems & re-formulates objectives according to evaluation findings

FIRST LEVEL OF ASSESSMENT

I. Presence of Health threats, Health deficits, Foreseeable crisis/ stress
points of the family.

A. Health Threats (Color the applicable vertical scrolls)

Family history of hereditary diseases
Specify disease/s: Hypertension
Family size beyond family resources
Threats of cross-infection from a communicable disease
Specify disease/s: cough and colds, fever
Inappropriate immunization status especially of children:
Poor environmental situation
Inadequate living space
Inadequate personal belongings/utensils
Lack of food storage
Polluted water supply
Presence of breeding places of insects and rodents
Improper refuse disposal
Improper drainage system
Poor ventilation and lightning
Noise pollution
Unsanitary food handling and preparation
Others, please specify: ____________________________
Inherent personality characteristics
Short temper
 Others, please specify:
_______________________________
Inappropriate role consumption
Child assuming mother’s role
Others, please specify:
_______________________________
Accident hazards
Broken stairs
Pointed sharp objects
Poison and medicines improperly kept
Fire hazards
Fall hazards
Others, please specify: Unprotected stairs
Nutritional
Inadequate food intake both in quality and quantity
Excessive intake of certain nutrients
Faulty eating habits
Others, please specify:
_________________________
Stress provoking factors
Strained marital relationship
Immature parents
Interpersonal conflicts between family members
Others, please specify:
_________________________
Personal habits/practices
Excessive smoking
Walking barefooted
Eating raw fish and meat
Poor personal hygiene
Self-medicated
 Others, please specify:
_________________________
Health history that may precipitate the occurrence of a health
problem
Specify: Hypertension
Family disunity
Self-oriented behaviour
Unresolved conflicts
Intolerable disagreements
Others, please specify:
_________________________
B. Health Deficits (Enumerable and discuss briefly)
 Malnutrition – The children shows signs and symptoms of
malnutrition (underweight, poor skin integrity)
 Diarrhea – one their children shows impending characteristics
of diarrhea that predisposes him in dehydration that may alter
the normal functioning of his body. Some of the manifestation
are frequent defecation in just one day and watery stool.

C. Stress points/foreseeable crisis situations

SECOND LEVEL OF ASSESSMENT

I. Inability to recognize the presence of a problem due to:
Ignorance of facts
Fear of consequences of diagnosis of problem
Social (Stigma, loss of respect of peer/significant
others)
Economic (Cost)
Physical/Psychological
Attitude/Philosophy in life
II. Inability to make decisions with respect to taking appropriate health
actions due to: (Color applicable horizontal boxes)
Failure to comprehend the nature, magnitude or scope of the
problem
Low salience of the problem
Feeling of confusion and resignation brought about by failure
to breakdown problems into manageable units of attack
Lack of knowledge/insight as to alternative course of action
open to them
Inability to decide which action to take among the list of
alternatives
Conflicting opinion among members regarding action to take
Ignorance of community resources for health care
Fear of consequences of action
Social
Economic
Physical/Psychological
Negative attitude toward the health problem
Lack of trust/confidence in health personnel/agency
Misconception of erroneous information about proposed
course/s of action
Inability of appropriate resources of care
Pregnancy, labor, puerperium
Parenthood
Additional member of the family
Abortion
Entrance at school
Adolescence
Loss of job
Death of a member
Illegitimacy
 Resettlement in a new community
Others, please specify:
______________________________
Physical (location)
Cost
III. Inability to provide nursing care to the sick, disabled, or dependent
member of the family due to: ( Color the applicable horizontal scrolls)
Ignorance of the facts about the disease/health condition
(Nature, severity, complications, prognosis, and management)
Ignorance of the nature and extent of the nursing care needed
Lack of necessary facilities (equipment and supplies) for care
Lack of knowledge and skill in carrying out the necessary
treatment/procedure/care
Inadequate resources for care
Responsible family member
Financial
Physical resources (e.g. isolation room)
Failure to see benefits (especially long term ones) of
investments in home environment improvement
Present of physical/psychological conflicts
Identify crisis/psychological conflicts
Jealousy/rivalry
Guilt feelings
Others, please specify:
_______________________________
Ignorance of preventive measures
Attitude/philosophy on life
Family disunity
Self-oriented behaviour of members
Intolerable disagreements
Lack of support to members in crisis
 Others, please specify:
_______________________________
IV. Inability to utilize community resources for health due to: ( Put Color
Green to the applicable horizontal scrolls)
Ignorance of lack of awareness of community resources for
health care
Failure to perceive benefits of health care/services
Lack of trust/confidence in health agency/personnel
Previous unpleasant experience with health worker
Fear of consequences of action
Physical/psychological
Financial
Social
Unavailability of required care/services
Inaccessibility of required care/services
Cost
Physical
Inadequate family services
Manpower
Financial
Feelings of alienation/lack of support form from the
community
Attitude/philosophy in life:
_______________________________________________________________________.

INITIAL DATA BASE FOR FAMILY NURSING PRACTICE

A. Family Structure, Characteristics, and Dynamics

Member of the Relationship age sex Civil Position in the family
household to the head of status
the family
Leland N. de Father/ 45 Male Married Father/husband
Leon husband
Marciana S. de wife 44 Female Married Mother/wife
Leon
 Mark Leland S. Son 19 Male Single Eldest child/son/brother
de Leon
Elaine S. de daughter 18 Female Single Youngest
Leon child/daughter/sister

Member of the Place of Type of Dominant family General family

household residence of family members in terms of relationship or
each member of structure decision making dynamics
the family
Leland N. de Living Patriarchal/ Short temper/
Leon independently nuclear easily irritated
Marciana S. de Living Patriarchal/ Good listener
Leon independently nuclear
Mark Leland S. Living with Patriarchal/ Joker
de Leon parents nuclear
Elaine S. de Living with Patriarchal/ Easily irritated
Leon parents nuclear

B. Socio-economic and Cultural Characteristics

Member of Income and expenses
the
household occupation Place of Income of Adequacy Who makes
work each working to meet decisions
member basic about
necessities money
Leland N. Production Bulacan P15,000.00/mo Adequate
de Leon manager
Marciana S. Landlady Manila P4,000.00/mo Adequate
de Leon
Mark BTM PUP
Leland S. student
de Leon
Elaine S. de BSN UERMMMC
Leon student

C. Home and Environment

The de Leon Family’s House is made of concrete and has three bedrooms, one
bathroom, a kitchen, and a living room which is just enough or adequate for their living
space. Every member of the family has their own bedrooms. Mr. and Mrs. de Leon share
bedrooms while the siblings have their own rooms. The Laundry area outside the house,
kitchen sink cabinet and the garbage cans are the resting sites of vectors of disease such
as flies, mosquitoes and roaches present in de Leon family’s house. Their foods are stored
in closed door cabinets and the refrigerator. The de Leon’s’ water supply comes from
deep well and not from NAWASA. They use water septic tank for their water supply.
The water coming from the septic tank is used for washing, cleaning, and bathing and not
for drinking purposes. The de Leon family buys distilled water from water refilling
stations. The de Leon family has their own bathroom and toilet. Their bathroom is near
the kitchen and is kept clean everyday by Mrs. de Leon and sometimes the siblings. Their
garbage is taken out everyday and collected by garbage trucks everyday. They have three
garbage cans inside the house, one is in the kitchen, the other, is in the bathroom and
lastly, near the bedroom. Mr. de Leon built a poso negro near the laundry area and is
been cleaned every once in a while to check for clogs. Their neighborhood is not
congested, there is still room for trees and plants to grow and place to play and hang-out.
They have their own telephone line and every family has their own cell phones. They
also have a family van for their transportation facility.

D. Health Status of Each Member

Member of the Medical and Nutritional assessment Risk factor

household nursing history assessment
Dietary Eating habits
history and practices
Leland N. de 4x a day Meat, fruits Cigarette and
Leon and tobacco
vegetables smoking
Marciana S. de Rheumatic 2x a day Sea foods
Leon heart disease
Mark Leland S. 4x a day Meat, fish, obesity
de Leon fruits and
vegetables
Elaine S. de dengue 3x a day meat, fruits, stress
Leon less
vegetables
and fish

E. Value, Habits, Practices on Health Promotion, Maintenance and Disease

Prevention
Member of the Immunization Healthy lifestyle Practices
household status of family
members

Leland N. de Leon complete Biking everyday

Marciana S. de Leon complete Stretching and eating fruits

Mark Leland S. de Leon complete Basketball (occasionally)

Elaine S. de Leon complete Badminton, Walking and eating

fruits
Adequacy of :

Member of Rest/ Exercises/ Use of protective Relaxation and

the sleep activities measures other stress
household management
activities
Leland N. de 9 10-20 Uses jacket Rest or watch TV
Leon hours minutes or listen to jazz
music
Marciana S. 8 5-10 Uses slippers in and out Rest and watch TV
de Leon hours minutes the house and umbrella

Mark Leland 6-8 1 hour Use pads Rest or eat

S. de Leon hours
Elaine S. de 6 1 hour Use umbrella when Rest and watch TV
Leon hours raining, and or surf the internet
handkerchiefs
FIRST LEVEL ASSESSMENT

SMOKING

Structured Questions:

1. Why do you smoke?

I smoke because it relieves my stress and it’s already been a habit and a
part of my everyday practice.

2. Do you know the consequences of smoking?

I know that smoking is dreadful for the health especially for the lungs but
smoking has already been a habit for me.

3. Did you try to stop smoking?

I did not try to stop smoking.

STRESS

Structured Questions:

1. Why are you always stressed out?

There are a lot of things I have to do so I sleep late and have to wake up
early to go to school.

2. Do you have enough rest or sleep?

No, because now that I’m in college. I usually sleep only for about 5 or 6
hours.

3. How do you relieve stress?

Whenever I came home from school, I tried to rest for an hour or just lay
back and watch TV
RHEUMATIC HEART DISEASE

Structured Questions:

1. What do you do to improve your health?

I drink my medicine on time and eat right amount of food.

2. Do you have regular check-ups with your doctor?

I usually go to heart center on the date that the doctor asked me to come
back

3. Do you take in alternative medicines or other herbal medicines you think that will
improve you current health?

I intake herbal drink and herbal supplements from recommendations from

friends and relatives. I also drink multivitamins and vitamin C tablets.
PRIORITIZATION

SMOKING

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 It is a health threat
Problem that does not
demand immediate
action
2/2 x 2 2 Resources are
2. Modifiability of available and
the Problem interventions are
feasible
3. Preventive 3/3 x 1 1 Smoking can be
Potential reduced or
minimized

4. Salience of the 1/2 x 1 0.5 The family

Problem recognizes it as a
problem. It does
not seem the
problem as needing
immediate action.
TOTAL SCORE 4.16

2. STRESS

Criteria Computation Actual Score Justification

1. Nature of the 2/3 x 1 0.66 It is a health threat
Problem that does not
demand immediate
action
2/2 x 2 2 Resources are
2. Modifiability of available and
the Problem interventions are
feasible.
3. Preventive 3/3 x 1 1 Stress can be
Potential reduced or
minimized
 4. Salience of the 1/2 x 1 0.5 The family
Problem recognizes it as a
problem but does
not required
immediate action
TOTAL SCORE 4.16

3. RHEUMATIC HEART DISEASE

Criteria Computation Actual Score Justification

1. Nature of the 3/3 x 1 1 It is a health deficit
Problem that requires
immediate
attention and
adequate
management.
1/2 x 2 2 Current knowledge,
2. Modifiability of interventions and
the Problem resources are
available to solve
the problem
3. Preventive 3/3 x 1 1 Disease can be
Potential prevented.

4. Salience of the 2/2 x 1 1 The family

Problem perceives it as a
serious problem
needing attention.
TOTAL SCORE 5

THE PRIORITIZED HEALTH PROBLEMS:

RANK 1 RHEUMATIC HEART 5

DISEASE
RANK 2 SMOKING 4.16
RANK 3 STRESS 4.16
FAMILY NURSING DIAGNOSIS
forget
HEALTH GOAL OF OBJECTIVES NURSING EVALUATI
PROBLEM CARE INTERVENT ON
FAMILY ION
DIAGNOSIS
Smoking To improve the General: 1. the client
1. inability condition of To eliminate or will be
to the client minimized able to
recogniz smoking habits. recogniz
e the e the bad
presence Specific: effects of
of the 1. to educate 1. Health smoking.
condition about the Teaching 2. the
or cause and patient
problem effects of will be
due to: smoking. able to
attitude/p eliminate
hilosoph 2. to provide 2. Guide the or
y in life activities family as minimize
which that will motivation d
hinders disregard al smoking.
recogniti from strategy.
on/accep smoking.
tance of
a 3. to give 3. discus
problem appropriate with the
2. inability medication family the
to make and cause and
decisions counseling effects of
with for the smoking
respect client and how
to taking does it
appropri affects
ate one’s
health health
action
due to:
failure to
compreh
end the
nature,
magnitud
e and
scope of
the
 problem
3. Inability
to
provide
adequate
nursing
care to
the sick,
disabled,
depende
nt or
vulnerabl
e/at-risk
member
of the
family
due to:
lack of
knowled
ge about
the
health
condition
4. inability
to
provide a
home
environ
ment
conduciv
e to
health
maintena
nce and
personal
develop
ment due
to;
negative
attitude /
philosop
hy in life
which is
not
conduciv
e to
 health
maintena
nce and
personal
develop
ment
5. Failure
to utilize
communi
ty
resources
for
health
care due
to: lack
of
inadequa
te
knowled
ge of
communi
ty
resources
for
health
care

HEALTH PROBLEM GOAL OF OBJECTIVES EVALUATION

FAMILY CARE
DIAGNOSIS
Stress
1. inability to
recognize the
presence of the
condition or
problem due
to: lack of or
inadequate
knowledge

2. inability to
make
decisions with
respect to
taking
appropriate
 health action
due to: failure
to comprehend
the
nature/magnitu
de of the
problem/condi
tion

3. Inability to
provide
adequate
nursing care to
the sick,
disabled,
dependent or
vulnerable/at-
risk member
of the family
due to:
4. inability to
provide a
home
environment
conducive to
health
maintenance
and personal
development
due to;
5. Failure to
utilize
community
resources for
health care due
to:

HEALTH PROBLEM GOAL OF OBJECTIV NURSING EVALUATION

FAMILY DIAGNOSIS CARE ES INTERVENTI
ON
Rheumatic Heart
Disease
1. inability to
recognize the
presence of the
condition or
 problem due to:
2. inability to make
decisions with
respect to taking
appropriate
health action due
to:
3. Inability to
provide adequate
nursing care to
the sick,
disabled,
dependent or
vulnerable/at-
risk member of
the family due
to:
4. inability to
provide a home
environment
conducive to
health
maintenance and
personal
development due
to;
5. Failure to utilize
community
resources for
health care due
to: