STEPS IN FAMILY ASSESSMENT

1. Data Collection
The following are brief description of common methods of
gathering data about a family:
A. Interview – using the health history format for each family
member.
B. Physical Assessment – using inspection. Palpation, percussion
and auscultation in examining of specific body parts and
reviewing the body system
C. Review of Records
D. Laboratory/diagnostic test results.
2. Data Analysis – the health worker should:
A. Sort out and classify or group the data by type or nature,
either as:
a.a. health threats
a.b. health deficits
a.c. stress points

B. Relate the data with each other and determines the patterns

C. Compare these data and the patterns with the norms or

standard

Standard of norms of the family as a functioning unit involves

the ability to perform the following FAMILY HEALTH TASKS which are
the:

a.a. recognize the presence of a health/condition problem

a.b. make decision about taking appropriate health actions.

a.c. provide nursing care to the sick, disabled, dependent, or

at-risk members
 a.d. maintain a home environment conductive to health
maintenance and personal development

D. After comparison of patterns with norms and standards,

assessment data that were categorized are interpreted (conclusion
of definition of a health problem), and inferences are drawn (health
threat, health deficit or stress)

The health problems identified constitute any of the following:

a. Transition statement from specific levels of wellness state or

health condition or problem
b. Medical or nursing diagnosis, current health status of each
member (health deficits)
c. Condition of home and environment that are conductive rto
disease or illness or accidents (Health threats)
d. Maturation of the development or situational crises
situations. (stress points/foreseeable crisis)

Family Diagnosis

Diagnosis – are family nursing problems or the end result of the family
assessment.

Health Problem – is a situation or condition which interferes with

the promotion and/or maintenance of health and recovery from
illness or injury

Health problems become a family nursing problem when it is

stated as a family’s failure to perform adequately specific health tasks
– this is called a nursing diagnosis in a family setting.

In the family, the health worker deals mostly with problems within
the domain of human behavior and less on physiological or clinical
condition requiring direct personal services as in hospital setting.
 Much of the health worker’s effort is directed at affecting
(causing) change in the behavior of client’s/family to achieve
optimum health.

There are six main categories of problems in family health care:

1. Presence of health threats, health deficits, and foreseeable

crises situations or stress points (result of first level assessment)

After identifying these problems, the health worker determines

the family’s incapability in the assumptions of the health tasks
(result of the second level assessment)
2. Inability to recognize the presence of the health problem due
to…
3. Inability to make decisions with respect to taking appropriate
actions due to…
4. Inability to provide a home environment which is conducive to
health maintenance and personal development due to…
5. Failure to utilize community resources for health care due to…

Family diagnosis consists of two parts:

1. The statement of the unhealthful response

2. The statement of factors which are maintaining the undesirable
response and preventing the desired change.

Example: a pregnant woman who is at the same time the

breadwinner of the family and who is not receiving health care.

General Problem: inability to utilize community resources for health

care due to lack of adequate family resources, specifically—

Specific problem: a. Financial resources

b. manpower resources

c. time
**the more specific the problem is defined, the more useful is the
diagnosis in determining nursing intervention.

Family Health Care Plan

I. Definition – a family care plan is the blue print of the care

that the health worker designs to systematically minimize or
eliminate the identified family health problems
How? Through steps.
a. Formulates outcome of care (goals and objectives)
b. Choosing set of interventions
c. Choosing resources
d. Choosing evaluation criteria, standards, methods and
tools
II. Characteristics of a Family Health Care Plan:
1. It focuses on actions, which are designed to solve or
minimize existing health problems. The plan is a blueprint
of action. It includes the approached, strategies,
activities, methods and materials to be used to improve or
solve the health problems.
2. It is the product of a deliberate, systemic, process. It is
characterized by logical analyses of the data that are
grouped together arrived a rational decision. The
interventions are chosen from among the alternatives
after careful analysis options.
3. It relates to the future. It utilizes events in the past and
what is happening in the present to determine patterns.
4. It is based upon identified health problem.
5. It is a means to an end, not an end itself. the goal in
planning is to deliver the most appropriate care to client
by eliminating barriers to family health development.
6. It is a continuous process.
III. Desirable qualities of a family health care plan.
1. It should be based on clear, explicit definition of the problem/s.
i. -the main as well as the contributory causes of the
health problem should be identified.
2. A good plan should be realistic.
- it can be implanted with a reasonable chance of success.
- the plan is related to the quantity and quality of resources
required in its implementation.
3. the plan is prepared jointly with the family.
- the health worker involves the family in determining the:
a. health needs and problems.
b. in establishing priorities.
c. in selecting appropriate courses of actions in
implementing the plan, evaluating these make
the family feel that the health of its member is a
family responsibility and a commitment

4. it is most useful in written form. It is a means of communication

among health workers.

IV. the importance of Planning the health Care:

1. They individualize the care of the clients. Nursing care should
suit and be unique to a particular client.
2. It helps in setting by providing information about the client as
well as the nature of his problems.
3. It promotes systematic communication among those
involved in the health care effort.
4. Continuity of care is facilitated.
5. It facilitates the coordination of care making known to other
members of the health team what the health worker is
doing.
V. Steps in developing a family health care plan:
1. Prioritize the family problems. The health worker may use a
scoring system.

There are 4 criteria in prioritizing family health problems:

a. Nature of the problem presented. The problem can be
categorized into health threat, health deficit,
foreseeable crisis.
·Health deficit has a greater weight than health threat
because the former usually demands more immediate
intervention and usually recognized or left by the
patient.
·Foreseeable crises is given to least weight because
culture-linked, the community usually provides
adequate support to the patient to cope with crises.
b. Modifiability of the problem – refers to the probability of
successes in maximizing, alleviating or totally
eradicating the problem through intervention.
The health worker considers the availability of the
following factors:
b.a. current knowledge, technology, and interventions
to manage the problems.
b.b. resources of the family – physical, financial, and
manpower.
b.c. resources of the health worker – knowledge, skills
and time
b.d. resources of the community – facilities and
community organization of support.
c. Preventive potential – refer to the nature and
magnitude of future problems that can be minimized or
 totally prevented if intervention is done on the problem
under consideration.

The following factors should be considered.

c.a. gravity and severity of the problem – refers to the
progress of the disease or problem indicating the
extent of damage on the patient/family, prognosis,
reversibility or modifiability of the problem.
c.b. duration of the problem – refers to the length of
time the problem has been existing.
c.c. current management – refers to the
appropriateness of the intervention measures instituted
to remedy the problem.
c.d. exposure to many high-risk group – this decreases
the preventive potential of the problem.
d. Salience – refers to the family’s perception and
evaluation of the problem in terms of seriousness and
urgency of attention needed
2. Formulation of goals and objectives of care.

Goal – is a general statement of the condition or state to be

bought about by specific courses of action.

Example: after intervention, the family will be able to take

care of the disabled child competently.

Objectives – refers to more specific statements of the desired

results or outcome of care.

·They specify the criteria by which the degree of

effectiveness of care is to be measured.

There are cardinal principles in formulating goals and

objectives of care:
 a. Goals must be set jointly with the family.
·this will help the family recognize and accept the existing
health needs and problems.
·This also ensures the family’s commitment to the
realization of the goals.

There are barriers to joint goal setting between the health worker and
the family.

a.a. failure on the part of the family to perceive the existence of

the problem

a.b. the family may realize the existence of a health problem but
is too busy at the moment with other concerns and pre-occupations

a.c. sometimes the family perceive the presence of the problem

but does not see it as serious enough to warrant attention

a.d. the family may perceive the presence of the problem and
the need to take action, however they refuse to face and do
something about the situation, due to…

-fear of consequences taking action. E.g., diagnosis of a disease

condition may mean expense or social stigma of the family

-respect for tradition – elders play a part in the decision making

-failure to perceive the benefits of actions proposed. E.g., if

health worker’s advice during the previous visit did not yield beneficial
results the advice is ignored the next time it is offered.

-failure to relate the proposed actions to the family goals. E.g.

economics and social goals generally occupy a higher priority than
health goals.

a.e. a big barrier to collaborate goal setting between health

worker and the family is failure to develop a working relationship.
 *unless the family sees the health worker as a friend who is
genuinely concerned with the welfare, nothing will be accomplished.

b. Goals should be realistic or attainable.

-too high goals and their consequent failure frustrate both
the family and the health worker
c. Goals, like objective, are the best stated in terms of client
outcomes, whether at the individual, family or community
level.
d. It should be specific.
-the more specific the goals or objectives, the easier is the
evaluation of their attainment.
e. Objectives vary according to the time span for their
realization:
e.a. Short term or immediate objectives – are formulated
for problem situations which requires immediate attention
and results can be observed in a short period of time.
They are accomplished with few health worker-family
contacts and the use of less resource.
e.b. Long-term or ultimate objectives – it requires a several
health worker-family encounters and an investment of
more resources. It also requires a longer period of time.
e.c. Medium-term or intermediate objectives – are those,
which are not immediately achieved

E.g., Goals: the family will manage malaria as a disease

and threat:
Short-term Objectives: The sick member/family will
take the drug accurately as to dose, frequency, duration
and drug combination.
 Medium-term objectives: All members of the family
will have medical check-up and laboratory confirmation
(blood smear) to diagnose malaria
Long-term Objective: All members of the family will
carry out mosquito vector control measures.
3. Selection of appropriate health interventions. The selection
based on the formulated goals and objective.

Guide in selection of appropriate nursing interventions:

a. Analyze with the family the current situation and determine

choices and possibilities based on actual experiences.
b. The family and the nurse should both analyze and understand
the present health/illness situation as the family experiences it.
c. Consider the knowledge, feelings and decision-making ability
of the family.
d. Consider the social relation of the family to its members and the
community.
e. Consider the available resources and equipment.
f. Focus on the interventions to help the family perform the health
tasks.
1. Help the family recognize the problem – by broadening the
family’s information on the nature, magnitude and cause of
the problem, helping the family see the consequences of
the situation/problem, relating health needs to the family
goals, encouraging positive attitude towards problem
solution.
2. Guide the family on how to decide on appropriate health
actions to take …
-explore with the family courses of actions available and
resources needed for each; discuss the consequences of
each action available.
 3. Develop the family’s ability and commitment to provide
nursing care to its members – through demonstrations and
practice sessions on procedures, treatments or techniques
using available, low-cost materials and equipment,
4. Enhance/increase the capability of the provide a home
environment conductive to health maintenance and
personal development – through teaching the family
specific techniques procedures on environmental
modification, management to minimize or eliminate health
threats or risks or to construct of modify needed facilities in
the home (like cleaning stream banks of overhanging
vegetations and debris to expose them to sunlight and
speed up water flow to eliminate breeding sites, constructing
family toilet.
5. Facilitate the family’s capability to utilize resources for health
care – through effective referral system.
g. Catalyze behavior change through motivation and support.
Example: Health worker can demonstrate to the mother how to
do the procedure. And while the mother is doing the
procedure, the health worker’s physical and psychological
availability are sources of support especially during experiences
of fear, doubt and helplessness.

4. Developing the Evaluation Plan.

The evaluation plan specifies how the health worker
will determine the achievement of outcomes of care
(goals and objectives). The plan includes the criteria,
standards, evaluation methods and sources of data.

IMPLEMENTING THE HEALTH CARE PLAN

I. General Information
There should be a dynamic and active involvement between the
health worker and the family in understanding and making choices.
II. The health worker should be an “Expert Caring” person. –it is
demonstrated when the health worker carries out interventions
based on the family’s understanding of the actual experiences of
coping and solving family problems.
- The health worker should be competent, which includes the
cognitive (knowledge), psychomotor (skills), and attitudinal
or affective (emotions, feelings, values)
- Expert Caring does not happen overnight to a new health
worker.
III. A great part of the implementation phase is directed
towards developing the family’s competencies to perform
the family health tasks

Examples:

Health Tasks: The family recognizes the possibility of cross-infection

of TB to other family members

Cognitive competencies:

a. The family explains the cause of TB.

b. The family enumerates mays by which cross-infection of TB
occur among family members.

Health Tasks: The family provides a home environment conducive

to health maintenance and personal development of its
members.

Psychomotor competencies:

a. The family carries the agreed-upon measures to improve home

sanitation and personal hygiene of family members.
 Health tasks: The family decides to take appropriate health
action

Attitudinal or affective competencies:

a. The family members express feelings or emotions that act as

barriers to decision-making.
b. Family members acknowledge the existence of these feelings
or emotions.

EVALUATION PHASE

Evaluation – is defined as the process of determining the value of

success in achieving predetermined objectives.

- It is the passing of judgment on the effectiveness of nursing

interventions of health programs.

Evaluation of the family health care is focused on:

1. The outcomes of nursing interventions among the individual

family members.
2. The family’s ability to perform its health tasks.
- The basic assumption is that if the family is able to perform its
health tasks, the health and well-being of its members is
improved, consequently improving their ability to deal with
their health and non-health problems.

Steps in Evaluation:

There are six steps in Evaluation process:

1. Describe what to evaluate – the objectives of the family health

care plan are the bases for evaluation
2. Design the evaluation plan. It means specifying the data
collection methods and tools.
There are different tools used to evaluate outcomes of
nursing interventions:
Thermometer, blood pressure apparatus, weighing
scale, tape measure or ruler, observation checklists and
questionnaires
3. Collect relevant data
4. Analyze the data – based on the objectives and criteria, one
can easily determine whether the intervention was effective or
not.
5. Make decisions. If the intervention or program was effective
and efficient, this could be applied to another client or group,
given similar circumstances. If there is another phase of the
program, then the positive evaluation results serve as a go-
signal to start the next phase. If the program is not relevant, the
evaluator should recommend its modification or termination.
6. Report and give feedback of results. The health worker should
give his/her clients feedback on the results of evaluation
through referrals to supervisor and/or doctor and should be
properly documented.