Pangasinan State University

Bayambang, Pangasinan
Bayambang Campus
Institute of Nursing

NCM 113- Community Health Nursing 2: Population Groups and Community as Clients

Student Name: ___________________________________

Year & Section: ___________________

Establishing a Working Relationship with the Client Family: __________________________________

Name of Family Head

CRITERIA CHECK IF DONE

(INDICATE DATE)

1. Initiate contact through home visit

2. Introduce yourself and your agency
3. Communicate interest in family welfare
4. Maintain a two-way communication with the family
5. Show willingness to help with expressed need/s.
Name of Family Head: ___________________________________
Address: __________________________________

List of Health Problems Nature of Problem

1.

2.

3.

4.

5.
Family No. _____________
Problem: ________________________________________________________

Criteria Standard Score Weight Actual Score Justification

1. Nature of the Health Deficit 3/ 1 1/

problem Health Threat 2 2/3
Foreseeable Crisis 1 1/3
2. Modifiability of the Easily Modifiable 2 2 2
problem Partially Modifiable 1/ 1/
Not Modifiable 0 0
3. Preventive High 3/ 1 1/
potential Moderate 2 2/3
Low 1 1/3
4. Salience of the Needs immediate attention 2/ 1 1/
problem Does not need immediate
attention 1 1/1
Not a problem 0 0

TOTAL SCORE: ______________________________

Example:
 Ranking Health Problems of Family Dela Cruz
PRIORIT PROBLEM SCORE
Y
1 cough & cold 4 2/3
2 Scabies 4
3 Malnutrition 3
4 No PWS 2
5 Pregnancy of Juana 1½

Ranking Health Problems of Family __________________

PRIORITY PROBLEM SCORE

Family No.: _________________

 Ranking Health Problems of Families in the Five Families: ______________________________

PRIORITY 1 FAMILY NAME PROBLEMS SCORE

10
Family Name: _________________________________

Health Problems Family Nursing Problem

First Level Assessment Second level Assessment

Name of Family: CABANTAC

 HEALTH PROBLEMS FAMILY NURSING GOALS OBJECTIVES INTERVENTIONS METHODS OF NURSING RESOURCES EVALUATION
PROBLEMS METHOD FAMILY CONTACT REQUIRED
DIABETES MELLITUS as I. Inability to make The family Short Term: - Discussed the - Virtual or Physical Material Short term:
Health Deficit decisions with respect will be able After the nursing possible causes of Assessment resources: The family was
to taking appropriate to: diabetes mellitus. -
interventions, able to
health action d/t - Stressed the - Interview method Glucomete
insufficient knowledge the family will be demonstrate
- Learn and importance of observation r
able to understanding
understand the maintaining - IEC
disease process demonstrate proper eating (Information, of the health
of Diabetes understanding of habits. education, and teachings with
Mellitus. the health - Encourage them communication) regards to the
- Know the early teachings with to have a regular materials disease
signs and regards to the check-up of blood process of
symptoms of glucose. Diabetes
disease process
Diabetes Mellitus. - Instruct diabetic Human
of Diabetes mellitus, signs
- Know the proper persons to have resources:
diet for Diabetic mellitus, signs proper foot care to - Clinical and symptoms,
persons. and symptoms, avoid cuts, bruises, Instructor and proper
and proper diet and wounds. s diet for
for diabetic - Brgy. diabetic
persons. Health persons.
workers
Long term:
Long Term: Financial The family was
After 3 weeks resources: be able to show
assuming of - Nursing behavior and
home visits, the students’ compliance on
family will be budget and how to control
expenses eating habits
able to show and
compliance on (proper diet).
how to control
eating habits
(proper diet).